Healthcare Provider Details

I. General information

NPI: 1497749170
Provider Name (Legal Business Name): TIRZAH R RICE P.A.-C
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3625 QUAIL RIDGE RD
WINFIELD KS
67156-8881
US

IV. Provider business mailing address

3625 QUAIL RIDGE RD
WINFIELD KS
67156-8881
US

V. Phone/Fax

Practice location:
  • Phone: 620-221-6100
  • Fax: 620-221-7680
Mailing address:
  • Phone: 620-221-6100
  • Fax: 620-221-7680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1064671
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: