Provider Demographics
NPI:1942752746
Name:R. PAYNE TRANSPORTATION LLC
Entity Type:Organization
Organization Name:R. PAYNE TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TRANSPORTER
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-574-2459
Mailing Address - Street 1:25336 CURIE AVE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48091-3822
Mailing Address - Country:US
Mailing Address - Phone:313-574-2459
Mailing Address - Fax:586-759-2359
Practice Address - Street 1:25336 CURIE AVE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48091-3822
Practice Address - Country:US
Practice Address - Phone:313-574-2459
Practice Address - Fax:586-759-2359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-27
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIP500744014148343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)