Provider Demographics
NPI:1881849222
Name:PAYNE, THOMAS FREDERICK JR (CRNA)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:FREDERICK
Last Name:PAYNE
Suffix:JR
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 732
Mailing Address - Street 2:
Mailing Address - City:CHANUTE
Mailing Address - State:KS
Mailing Address - Zip Code:66720-0732
Mailing Address - Country:US
Mailing Address - Phone:620-212-0588
Mailing Address - Fax:
Practice Address - Street 1:1110 W ELM ST
Practice Address - Street 2:
Practice Address - City:CHANUTE
Practice Address - State:KS
Practice Address - Zip Code:66720-1430
Practice Address - Country:US
Practice Address - Phone:620-212-0588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-26
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022038981367500000X
KS1393470091367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO910017262Medicaid