Healthcare Provider Details

I. General information

NPI: 1972214534
Provider Name (Legal Business Name): JUSTIN COLE RICE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2022
Last Update Date: 01/03/2024
Certification Date: 11/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PADUCAH DR STE B
NEW MARTINSVILLE WV
26155-2710
US

IV. Provider business mailing address

208 UNIVERSITY DR
WEST LIBERTY WV
26074-1082
US

V. Phone/Fax

Practice location:
  • Phone: 304-815-0050
  • Fax: 304-815-0051
Mailing address:
  • Phone: 304-336-5098
  • Fax: 304-336-8868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: