=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073614160
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MATTHEW RICE DO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/25/2006
-----------------------------------------------------
Last Update Date | 05/23/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 803 S MAIN ST STE 120
-----------------------------------------------------
City | MOSCOW
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83843-2695
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-848-8300
-----------------------------------------------------
Fax | 509-444-7806
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 203 N WASHINGTON ST STE 300
-----------------------------------------------------
City | SPOKANE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 99201-0254
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-444-8888
-----------------------------------------------------
Fax | 509-444-7806
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | O229
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------