1124011341 NPI number — MARY MARTHA REAMS MD

Table of content: MARY MARTHA REAMS MD (NPI 1124011341)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124011341 NPI number — MARY MARTHA REAMS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REAMS
Provider First Name:
MARY
Provider Middle Name:
MARTHA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1124011341
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/10/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2057
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ASHLAND
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41105-2057
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-329-0799
Provider Business Mailing Address Fax Number:
606-329-0947

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
613 23RD ST STE 350
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ASHLAND
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41101-2879
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-408-4600
Provider Business Practice Location Address Fax Number:
606-408-4605
Provider Enumeration Date:
08/23/2005

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: 207W00000X , with the licence number:  20802 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0545093 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5484 . This is a "MEDICARE GROUP NUMBER" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 64208028 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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