Provider Demographics
NPI:1598747685
Name:RICE, JON F (CPO)
Entity Type:Individual
Prefix:MR
First Name:JON
Middle Name:F
Last Name:RICE
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:JON
Other - Middle Name:
Other - Last Name:LEWIS-RICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPO
Mailing Address - Street 1:640 VILLAGE PARK DR
Mailing Address - Street 2:#201
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-3688
Mailing Address - Country:US
Mailing Address - Phone:910-473-2826
Mailing Address - Fax:
Practice Address - Street 1:3909 OLEANDER DR
Practice Address - Street 2:SUITE E
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6730
Practice Address - Country:US
Practice Address - Phone:910-395-5775
Practice Address - Fax:910-395-5773
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7795132Medicaid