MEDICARE: MICHAEL S PAYNE MD

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	34039	KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00080686	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	2443395000	OTHER		PASSPORT ADVANTAGE
3	50001836	OTHER	KY	PASSPORT
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	7088131	OTHER		AETNA
6	000000306485	OTHER		BCBS

General Provider Information

NPI Number	:	1467554808
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL S PAYNE MD

Provider Business Mailing Address
First Line	:	532 N BARDSTOWN RD
Second Line	:	PO BOX 67
City	:	MT WASHINGTON
State	:	KY
Zip	:	40047
Country	:	US
Telephone Number	:	502-538-4800
Fax Number	:	502-538-3040

Provider Business Practice Location Address
First Line	:	532 N BARDSTOWN RD
Second Line	:
City	:	MT WASHINGTON
State	:	KY
Zip	:	40047
Country	:	US
Telephone Number	:	502-538-4800
Fax Number	:	502-538-3040

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/05/2006
Last Update Date	:	11/14/2011

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Directions to “ MICHAEL S PAYNE MD” Practice Location

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