Provider Demographics
NPI:1366618407
Name:VICE ORTHOPEDICS & SPORTS MEDICINE, PC
Entity type:Organization
Organization Name:VICE ORTHOPEDICS & SPORTS MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:C
Authorized Official - Last Name:VICE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:276-228-8422
Mailing Address - Street 1:710 W RIDGE RD
Mailing Address - Street 2:SUITE H
Mailing Address - City:WYTHEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24382-1095
Mailing Address - Country:US
Mailing Address - Phone:276-228-8422
Mailing Address - Fax:
Practice Address - Street 1:710 W RIDGE RD
Practice Address - Street 2:SUITE H
Practice Address - City:WYTHEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24382-1095
Practice Address - Country:US
Practice Address - Phone:276-228-8422
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty