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General NPI Number Information
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NPI Number | 1508194481
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Entity Type | Individual
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Provider Name | TICE JAMES RANDOLPH
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Gender | Male
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Dates
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Enumeration Date | 12/03/2009
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Last Update Date | 12/03/2009
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Provider Practice Location Address
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Address Line | 123 S MAIN ST
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City | MARION
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State | NC
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Zip | 28752-4548
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Country | US
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Telephone | 828-659-8879
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Fax | 828-659-6888
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Provider Business Mailing Address
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Address Line | 123 S MAIN ST
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City | MARION
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State | NC
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Zip | 28752-4548
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Country | US
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Telephone | 828-659-8879
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Fax | 828-659-6888
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | HC2338
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License Number State | NC
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