Provider Demographics
NPI:1790950194
Name:PAYSON PHYSICIAN SERVICES CORPORATION
Entity Type:Organization
Organization Name:PAYSON PHYSICIAN SERVICES CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:MAUREEN
Authorized Official - Last Name:DRISCOLL-LOWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:9289-468-0210
Mailing Address - Street 1:PO BOX 1240
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85547-1240
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2810 E PINEGATE CT
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:AZ
Practice Address - Zip Code:85541-1938
Practice Address - Country:US
Practice Address - Phone:928-468-0210
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ29310261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care