Provider Demographics
NPI:1497749170
Name:RICE, TIRZAH R (PA-C)
Entity Type:Individual
Prefix:
First Name:TIRZAH
Middle Name:R
Last Name:RICE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3625 QUAIL RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:KS
Mailing Address - Zip Code:67156-8881
Mailing Address - Country:US
Mailing Address - Phone:620-221-6100
Mailing Address - Fax:620-221-7680
Practice Address - Street 1:3625 QUAIL RIDGE RD
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:KS
Practice Address - Zip Code:67156-8881
Practice Address - Country:US
Practice Address - Phone:620-221-6100
Practice Address - Fax:620-221-7680
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1064671363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS426801Medicare ID - Type UnspecifiedMEDICARE
KSQ29491Medicare UPIN