=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396764015
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN EDWARD RICE III M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/19/2006
-----------------------------------------------------
Last Update Date | 08/25/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3 HOSPITAL DR SUITE 212
-----------------------------------------------------
City | LEWISBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17837-9362
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-522-9771
-----------------------------------------------------
Fax | 570-522-9772
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 HOSPITAL DR SUITE 306
-----------------------------------------------------
City | LEWISBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17837-9350
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-522-4110
-----------------------------------------------------
Fax | 570-768-3911
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084N0600X
-----------------------------------------------------
Taxonomy Name | Clinical Neurophysiology Physician
-----------------------------------------------------
License Number | MD027740E
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2084N0400X
-----------------------------------------------------
Taxonomy Name | Neurology Physician
-----------------------------------------------------
License Number | MD027740E
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------