Provider Demographics
NPI:1821063405
Name:RICE, THOMAS KEVIN (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:KEVIN
Last Name:RICE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:KEVIN
Other - Middle Name:
Other - Last Name:RICE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:106 BLANCA AVE
Mailing Address - Street 2:
Mailing Address - City:ALAMOSA
Mailing Address - State:CO
Mailing Address - Zip Code:81101-2340
Mailing Address - Country:US
Mailing Address - Phone:719-589-3000
Mailing Address - Fax:719-587-1372
Practice Address - Street 1:2115 STUART AVE
Practice Address - Street 2:
Practice Address - City:ALAMOSA
Practice Address - State:CO
Practice Address - Zip Code:81101-2269
Practice Address - Country:US
Practice Address - Phone:719-589-8008
Practice Address - Fax:719-589-8112
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO45376208100000X
IL208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CORI45376OtherANTHEM BC/BS
CO840255530064OtherROCKY MTN HEALTH PLANS
CO53938216Medicaid
COP00423071OtherMEDICARE RAILROAD CARRIER
COE49115Medicare UPIN
COP00423071OtherMEDICARE RAILROAD CARRIER