Provider Demographics
NPI:1164439204
Name:JOHN V RICE DPM
Entity Type:Organization
Organization Name:JOHN V RICE DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GRETCHEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:RICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-427-0366
Mailing Address - Street 1:P.O. BOX 266
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:WA
Mailing Address - Zip Code:98584
Mailing Address - Country:US
Mailing Address - Phone:360-427-0366
Mailing Address - Fax:360-427-5879
Practice Address - Street 1:1812 N 13TH LOOP RD
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:WA
Practice Address - Zip Code:98584-2169
Practice Address - Country:US
Practice Address - Phone:360-427-0366
Practice Address - Fax:360-427-5879
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOHN V RICE DPM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-02
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO412213ES0103X
261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB36452Medicare PIN
AB36452Medicare UPIN