Provider Demographics
NPI:1952440232
Name:ALBERT E. PAYNE, MD, INC
Entity Type:Organization
Organization Name:ALBERT E. PAYNE, MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SNODGRASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-923-8666
Mailing Address - Street 1:600 PORTAGE TRL
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44221-3055
Mailing Address - Country:US
Mailing Address - Phone:330-923-8666
Mailing Address - Fax:330-923-0244
Practice Address - Street 1:600 PORTAGE TRL
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44221-3055
Practice Address - Country:US
Practice Address - Phone:330-923-8666
Practice Address - Fax:330-923-0244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35045395P174400000X
OHNP01169174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0504725Medicaid
OH0504725Medicaid
OH9360401Medicare PIN