Organization
BLAINE PAYNE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TAMMEY REVELS (BUSINESS MANAGER)
(850) 973-1215
Entity
Organization
Contact information
Practice address
180 NW HAYNES ST, MADISON, FL 32340-2010
(850) 973-1215
(866) 923-4163
Mailing address
PO BOX 185, MADISON, FL 32341-0185
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
OS9255
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
272752800
—
FL
01
—
37137
BCBS
—
01
—
HUMANA
HUMANA
—
01
—
SXJQY
BCBS
—
Enumeration date
02/23/2016
Last updated
06/30/2016
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