Provider Demographics
NPI:1356034045
Name:VICE, BRIAN ALLEN (APSS)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:ALLEN
Last Name:VICE
Suffix:
Gender:M
Credentials:APSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 WILLOW DELL DR
Mailing Address - Street 2:
Mailing Address - City:EWING
Mailing Address - State:KY
Mailing Address - Zip Code:41039-8492
Mailing Address - Country:US
Mailing Address - Phone:606-748-8797
Mailing Address - Fax:
Practice Address - Street 1:104 S FRONT AVE
Practice Address - Street 2:
Practice Address - City:PRESTONSBURG
Practice Address - State:KY
Practice Address - Zip Code:41653-1614
Practice Address - Country:US
Practice Address - Phone:606-886-8572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty