1598733412 NPI number — TAMARA RICE MD

Table of content: TAMARA RICE MD (NPI 1598733412)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598733412 NPI number — TAMARA RICE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RICE
Provider First Name:
TAMARA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VAN DERAA
Provider Other First Name:
TAMARA
Provider Other Middle Name:
DEE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1598733412
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2817 SAINT JOHNS BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JOPLIN
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64804-1563
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-781-2727
Provider Business Mailing Address Fax Number:
417-625-2279

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2817 SAINT JOHNS BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JOPLIN
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64804-1563
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-781-2727
Provider Business Practice Location Address Fax Number:
417-625-2279
Provider Enumeration Date:
03/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  2002008193 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207LA0401X , with the licence number: 2002008193 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207LC0200X , with the licence number: 2002008193 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207LP2900X , with the licence number: 2002008193 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100420090B , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100062670A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 205839707 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 116969500 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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