1376638684 NPI number — REED A HITTLE P.T.

Table of content: REED A HITTLE P.T. (NPI 1376638684)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376638684 NPI number — REED A HITTLE P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HITTLE
Provider First Name:
REED
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376638684
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
530 IOWA SE SUITE 105
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HURON
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57350
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-352-2169
Provider Business Mailing Address Fax Number:
605-352-9782

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
530 IOWA SE SUITE 105
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HURON
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57350
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-352-2169
Provider Business Practice Location Address Fax Number:
605-352-9782
Provider Enumeration Date:
10/03/2006

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: 225100000X , with the licence number:  0152 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 9230402 . This is a "DAKOTACARE" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 5833072 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 20677 . This is a "SVHP" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 4994646 . This is a "BCBS" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 4167890001 . This is a "DME- CIGNA" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: A002 . This is a "TRICARE" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: HA4001 . This is a "TLC" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: A137603 . This is a "MULTI-PLAN EOS" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 1923246 . This is a "FIRST HEALTH" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 64-06449 . This is a "MEDICA" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".




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