Provider Demographics
NPI:1437339884
Name:RICE, THERON J III (PA-C)
Entity Type:Individual
Prefix:MR
First Name:THERON
Middle Name:J
Last Name:RICE
Suffix:III
Gender:M
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:3024 BUSINESS PARK CIR
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-3132
Mailing Address - Country:US
Mailing Address - Phone:615-239-2018
Mailing Address - Fax:615-851-2018
Practice Address - Street 1:500 NORTHCREST DRIVE, SUITE 521
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:TN
Practice Address - Zip Code:37172-4066
Practice Address - Country:US
Practice Address - Phone:615-391-4545
Practice Address - Fax:615-391-4546
Is Sole Proprietor?:No
Enumeration Date:2007-11-13
Last Update Date:2023-10-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TNPA1555363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNPENDINGOtherBLUE CROSS BLUE SHIELD
TN3665167Medicare PIN