=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386815876
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PAYNE FAMILY MEDICINE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/12/2008
-----------------------------------------------------
Last Update Date | 06/29/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2201 CHARLES ST SUITE 102
-----------------------------------------------------
City | FREDERICKSBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22401-3378
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-845-4139
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2201 CHARLES ST SUITE 102
-----------------------------------------------------
City | FREDERICKSBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22401-3378
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-845-4139
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTOR
-----------------------------------------------------
Name | DR. MERCEDES VALENCIA PAYNE
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 540-845-4139
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 0021550280
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------