Provider Demographics
NPI:1629587886
Name:PAYNE, JORDAN (BA)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:PAYNE
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 CINCINNATI BATAVIA PIKE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45244-1557
Mailing Address - Country:US
Mailing Address - Phone:513-732-8800
Mailing Address - Fax:513-732-8806
Practice Address - Street 1:4629 AICHOLTZ ROAD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45244
Practice Address - Country:US
Practice Address - Phone:513-732-8800
Practice Address - Fax:513-732-8806
Is Sole Proprietor?:No
Enumeration Date:2017-09-20
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator