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General NPI Number Information
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NPI Number | 1528537057
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Entity Type | Organization
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Legal Business Name | CAYCE MEDICAL SPA, INC
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Dates
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Enumeration Date | 11/14/2018
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Last Update Date | 11/14/2018
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Provider Practice Location Address
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Address Line | 2001 CORONA RD STE 201
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City | COLUMBIA
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State | MO
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Zip | 65203-5924
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Country | US
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Telephone | 573-234-6930
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Fax |
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Provider Business Mailing Address
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Address Line | 2001 CORONA RD STE 201
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City | COLUMBIA
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State | MO
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Zip | 65203-5924
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Country | US
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Telephone | 573-234-6930
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | CANDYCE PAYNE
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Credential | ADMINISTRATOR
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Telephone | 573-234-6930
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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