Provider Demographics
NPI:1417287814
Name:AMY M ICE, PLLC
Entity Type:Organization
Organization Name:AMY M ICE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:M
Authorized Official - Last Name:ICE
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:432-697-5865
Mailing Address - Street 1:PO BOX 4157
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79704-4157
Mailing Address - Country:US
Mailing Address - Phone:432-520-0291
Mailing Address - Fax:432-520-2723
Practice Address - Street 1:4519 N GARFIELD ST
Practice Address - Street 2:SUITE 15
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79705-3415
Practice Address - Country:US
Practice Address - Phone:432-520-0291
Practice Address - Fax:432-520-2723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-06
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX648252367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty