Provider Demographics
NPI:1013757194
Name:RICE, MATT
Entity type:Individual
Prefix:
First Name:MATT
Middle Name:
Last Name:RICE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 N BELL
Mailing Address - Street 2:
Mailing Address - City:CERRO GORDO
Mailing Address - State:IL
Mailing Address - Zip Code:61818-4127
Mailing Address - Country:US
Mailing Address - Phone:217-512-3925
Mailing Address - Fax:
Practice Address - Street 1:503 N BELL
Practice Address - Street 2:
Practice Address - City:CERRO GORDO
Practice Address - State:IL
Practice Address - Zip Code:61818-4127
Practice Address - Country:US
Practice Address - Phone:217-512-3925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-28
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications