Provider Demographics
NPI:1447985684
Name:VICE, THOMAS COLEMAN
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:COLEMAN
Last Name:VICE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6231 MUNICIPAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:LOXLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36551-3147
Mailing Address - Country:US
Mailing Address - Phone:251-271-1179
Mailing Address - Fax:
Practice Address - Street 1:6231 MUNICIPAL PARK DR
Practice Address - Street 2:
Practice Address - City:LOXLEY
Practice Address - State:AL
Practice Address - Zip Code:36551-3147
Practice Address - Country:US
Practice Address - Phone:251-271-1179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians