Provider Demographics
NPI:1588745863
Name:RICE, JASON T (DO)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:T
Last Name:RICE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 628
Mailing Address - Street 2:
Mailing Address - City:PAINTSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41240-0628
Mailing Address - Country:US
Mailing Address - Phone:606-788-0303
Mailing Address - Fax:606-788-0310
Practice Address - Street 1:604 JAMES S TRIMBLE BOULEVARD
Practice Address - Street 2:SUITE 1
Practice Address - City:PAINTSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41240-1026
Practice Address - Country:US
Practice Address - Phone:606-788-0303
Practice Address - Fax:606-788-0310
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY02837207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64080971Medicaid
KY0925001Medicare ID - Type Unspecified
KY64080971Medicaid