1871593178 NPI number — DR. TRACY MARIA REED DPM

Table of content: DR. TRACY MARIA REED DPM (NPI 1871593178)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871593178 NPI number — DR. TRACY MARIA REED DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REED
Provider First Name:
TRACY
Provider Middle Name:
MARIA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
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:
1871593178
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/10/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 959354
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63195-9354
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-953-8223
Provider Business Mailing Address Fax Number:
314-273-1654

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11125 DUNN ROAD SUITE 301
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63195-4952
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-953-8223
Provider Business Practice Location Address Fax Number:
314-273-1654
Provider Enumeration Date:
07/28/2005

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: 213E00000X , with the licence number:  000797 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2700520 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 133181 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 304715402 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 431866203 . This is a "COMMUNITY CARE PLUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 480035186 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7805244 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 463755 . This is a "HEALTHLINK INC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 550812530 . This is a "MERCY HEALTH PLAN" identifier . This identifiers is of the category "OTHER".




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