Provider Demographics
NPI:1407040918
Name:TIM NICE M.D. INC
Entity Type:Organization
Organization Name:TIM NICE M.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:J
Authorized Official - Last Name:NICE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-585-5258
Mailing Address - Street 1:34600 CHARDON ROAD
Mailing Address - Street 2:SUITE 9
Mailing Address - City:WILLOUGHBY HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44094
Mailing Address - Country:US
Mailing Address - Phone:440-585-5258
Mailing Address - Fax:440-944-5278
Practice Address - Street 1:34600 CHARDON ROAD
Practice Address - Street 2:SUITE 9
Practice Address - City:WILLOUGHBY HILLS
Practice Address - State:OH
Practice Address - Zip Code:44094
Practice Address - Country:US
Practice Address - Phone:440-585-5258
Practice Address - Fax:440-944-5278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35036891174400000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0321851Medicaid
OH0404012Medicare PIN
OH0321851Medicaid