Healthcare Provider Details

I. General information

NPI: 1164030763
Provider Name (Legal Business Name): BRICE DUVALL GLASSCOCK CAS, NCAC I
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2020
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

889 PARK AVE
MEEKER CO
81641
US

IV. Provider business mailing address

PO BOX 1352
MEEKER CO
81641-1352
US

V. Phone/Fax

Practice location:
  • Phone: 970-942-8306
  • Fax:
Mailing address:
  • Phone: 970-942-8306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number007371
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberACC.0021111
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: