Provider Demographics
NPI:1700296308
Name:PAYNE, CHARLES (RRT, SDS)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:
Last Name:PAYNE
Suffix:
Gender:M
Credentials:RRT, SDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 LYNN ST
Mailing Address - Street 2:
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601
Mailing Address - Country:US
Mailing Address - Phone:231-878-0578
Mailing Address - Fax:231-876-7160
Practice Address - Street 1:803 LYNN ST
Practice Address - Street 2:
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-2336
Practice Address - Country:US
Practice Address - Phone:231-878-0578
Practice Address - Fax:231-876-7160
Is Sole Proprietor?:No
Enumeration Date:2014-05-05
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4401005919246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other