Provider Demographics
NPI:1497882526
Name:CHARLES W RICE DPM PC
Entity Type:Organization
Organization Name:CHARLES W RICE DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:RICE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:814-371-6442
Mailing Address - Street 1:90 BEAVER DR
Mailing Address - Street 2:BUILDING 'D'
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-2440
Mailing Address - Country:US
Mailing Address - Phone:814-371-6442
Mailing Address - Fax:814-371-4245
Practice Address - Street 1:90 BEAVER DR
Practice Address - Street 2:BUILDING 'D'
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-2440
Practice Address - Country:US
Practice Address - Phone:814-371-6442
Practice Address - Fax:814-371-4245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002358L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAT28622Medicare UPIN
5853210001Medicare NSC