MEDICARE: WILLIAM W PAYNE III CRNA

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	367500000X	Certified Registered Nurse Anesthetist	074459	PA

General Provider Information

NPI Number	:	1699711440
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM W PAYNE III CRNA

Provider Business Mailing Address
First Line	:	320 E NORTH AVE
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15212-4756
Country	:	US
Telephone Number	:	412-359-6581
Fax Number	:	412-359-3483

Provider Business Practice Location Address
First Line	:	1699 WASHINGTON RD
Second Line	:	SUITE 400
City	:	PITTSBURGH
State	:	PA
Zip	:	15228-1629
Country	:	US
Telephone Number	:	412-851-1820
Fax Number	:	412-851-1822

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

Provider Enumeration Date	:	06/21/2006
Last Update Date	:	10/09/2020

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