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General NPI Number Information
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NPI Number | 1225606551
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Entity Type | Individual
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Provider Name | PAYTON RILEY PTACEK BS, MPA, MCJ
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Gender | Female
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Dates
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Enumeration Date | 06/14/2021
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Last Update Date | 03/19/2025
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Provider Practice Location Address
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Address Line | 1484 N M 52
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City | OWOSSO
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State | MI
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Zip | 48867-1235
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Country | US
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Telephone | 770-373-5822
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Fax | 248-712-4381
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Provider Business Mailing Address
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Address Line | 2100 HEMMETER RD
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City | SAGINAW
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State | MI
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Zip | 48603-3944
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Country | US
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Telephone | 989-799-2100
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Fax | 989-799-2637
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156F00000X
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Taxonomy Name | Technician/Technologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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