Healthcare Provider Details

I. General information

NPI: 1053447953
Provider Name (Legal Business Name): JOHN H PAYNE ASSOC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 01/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 WEST 86TH ST 101
INDIANAPOLIS IN
46260
US

IV. Provider business mailing address

2020 WEST 86TH STREET 101
INDIANAPOLIS IN
46260
US

V. Phone/Fax

Practice location:
  • Phone: 317-872-1557
  • Fax: 317-872-6042
Mailing address:
  • Phone: 317-872-1557
  • Fax: 317-872-6042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT H PAYNE
Title or Position: PRESIDENT CLINICAL DIRECTOR
Credential:
Phone: 317-872-1557