Provider Demographics
NPI:1184262792
Name:PAYNE FREE LIVING,LLC
Entity type:Organization
Organization Name:PAYNE FREE LIVING,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:A
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:HIS
Authorized Official - Phone:501-701-4388
Mailing Address - Street 1:1029 SLATECREEK WAY
Mailing Address - Street 2:
Mailing Address - City:LONSDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72087-9710
Mailing Address - Country:US
Mailing Address - Phone:501-276-3431
Mailing Address - Fax:844-273-2941
Practice Address - Street 1:1217 MALVERN AVE STE C
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-6375
Practice Address - Country:US
Practice Address - Phone:501-701-4388
Practice Address - Fax:844-273-2941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-13
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR605OtherHIS LICENSE NUMBER