1962753319 NPI number — REID PHYSICIAN ASSOCIATES, INC

Table of content: (NPI 1962753319)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962753319 NPI number — REID PHYSICIAN ASSOCIATES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REID PHYSICIAN ASSOCIATES, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1962753319
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/22/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
07/22/2015
NPI Reactivation Date:
09/22/2015

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1100 REID PKWY
Provider Second Line Business Mailing Address:
MEDICAL STAFF SERVICES
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47374-1157
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
765-983-3127
Provider Business Mailing Address Fax Number:
765-983-3219

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 S OAK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINCHESTER
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47394-2225
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-584-6600
Provider Business Practice Location Address Fax Number:
765-584-6503
Provider Enumeration Date:
09/25/2012

Additional Information

Authorized Official

Authorized Official Last Name:
HUTH
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
765-983-3202

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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