MEDICARE: PAYSON HEALTHCARE MANAGEMENT INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207R00000X	Internal Medicine Physician
2	207V00000X	Obstetrics & Gynecology Physician
3	208000000X	Pediatrics Physician
4	2085R0202X	Diagnostic Radiology Physician
5	207RC0000X	Cardiovascular Disease Physician
6	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1093718694
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAYSON HEALTHCARE MANAGEMENT INC

Provider Business Mailing Address
First Line	:	7100 COMMERCE WAY
Second Line	:	SUITE 180
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-2829
Country	:	US
Telephone Number	:	615-465-7000
Fax Number	:

Provider Business Practice Location Address
First Line	:	126 E MAIN ST STE B
Second Line	:
City	:	PAYSON
State	:	AZ
Zip	:	85541-5488
Country	:	US
Telephone Number	:	928-472-4675
Fax Number	:	928-472-3427

Authorized Official
Title or Position	:	DIRECTOR OF PROVIDER ENROLLMENT
Name	:	DEBBIE BREWER
Credential	:
Telephone Number	:	615-465-7626

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	01/21/2008

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