Provider Demographics
NPI:1417035668
Name:RICE, DAVID SHANE (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:SHANE
Last Name:RICE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 ESTO HTS
Mailing Address - Street 2:
Mailing Address - City:RUSSELL SPRINGS
Mailing Address - State:KY
Mailing Address - Zip Code:42642-6941
Mailing Address - Country:US
Mailing Address - Phone:270-343-5038
Mailing Address - Fax:
Practice Address - Street 1:313 ESTO HTS
Practice Address - Street 2:
Practice Address - City:RUSSELL SPRINGS
Practice Address - State:KY
Practice Address - Zip Code:42642-6941
Practice Address - Country:US
Practice Address - Phone:270-343-5038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY600081282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYC67391Medicare UPIN