MEDICARE: BILLY JOEL VICE R.N

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WE0003X	Emergency Registered Nurse	1-076774	AL

General Provider Information

NPI Number	:	1689840217
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BILLY JOEL VICE R.N

Provider Business Mailing Address
First Line	:	119 BOYD PL
Second Line	:
City	:	RAINBOW CITY
State	:	AL
Zip	:	35906-6507
Country	:	US
Telephone Number	:	256-442-5552
Fax Number	:

Provider Business Practice Location Address
First Line	:	5401 E LAKE BLVD
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35217-3545
Country	:	US
Telephone Number	:	205-808-3381
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2008
Last Update Date	:	05/04/2008

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Directions to “ BILLY JOEL VICE R.N” Practice Location

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