MEDICARE: CAYCE MEDICAL SPA, INC

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	207N00000X	Dermatology Physician

General Provider Information

NPI Number	:	1528537057
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAYCE MEDICAL SPA, INC

Provider Business Mailing Address
First Line	:	2001 CORONA RD STE 201
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65203-5924
Country	:	US
Telephone Number	:	573-234-6930
Fax Number	:

Provider Business Practice Location Address
First Line	:	2001 CORONA RD STE 201
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65203-5924
Country	:	US
Telephone Number	:	573-234-6930
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	CANDYCE PAYNE
Credential	:	ADMINISTRATOR
Telephone Number	:	573-234-6930

Provider Enumeration Date	:	11/14/2018
Last Update Date	:	11/14/2018

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Directions to “CAYCE MEDICAL SPA, INC ” Practice Location

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