1790992873 NPI number — MR. WILLIAM R. REEVES RPH, PHC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790992873 NPI number — MR. WILLIAM R. REEVES RPH, PHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REEVES
Provider First Name:
WILLIAM
Provider Middle Name:
R.
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
RPH, PHC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
REEVES
Provider Other First Name:
BILL
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RPH, PHC
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1790992873
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/10/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
465 SAINT MICHAELS DR
Provider Second Line Business Mailing Address:
SUITE 110
Provider Business Mailing Address City Name:
SANTA FE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87505-7670
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-913-5287
Provider Business Mailing Address Fax Number:
505-913-4949

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
455 SAINT MICHAELS DR
Provider Second Line Business Practice Location Address:
ST. VINCENT HOSPITAL, ANTICOAGULATION MANAGEMENT SERVIC
Provider Business Practice Location Address City Name:
SANTA FE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87505-7601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-913-5287
Provider Business Practice Location Address Fax Number:
505-913-4949
Provider Enumeration Date:
05/17/2007

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: 1835P1200X , with the licence number:  00000066 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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