Basic Information
Provider Information
NPI: 1194207316
EntityType: 2
ReplacementNPI:  
OrganizationName: REID PHYSICIAN ASSOCIATES INC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: REID HEALTH LABORATORY - CONNERSVILLE
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1100 REID PKWY
Address2: MEDICAL STAFF SERVICES
City: RICHMOND
State: IN
PostalCode: 473741157
CountryCode: US
TelephoneNumber: 7659833127
FaxNumber: 7659833219
Practice Location
Address1: 1475 E STATE ROAD 44 STE 4
Address2:  
City: CONNERSVILLE
State: IN
PostalCode: 473318383
CountryCode: US
TelephoneNumber: 7658271946
FaxNumber: 7658275692
Other Information
ProviderEnumerationDate: 09/04/2018
LastUpdateDate: 09/04/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: NASH
AuthorizedOfficialFirstName: MISTY
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: DIRECTOR
AuthorizedOfficialTelephone: 7659833127
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
291U00000X  Y LaboratoriesClinical Medical Laboratory 

No ID Information.


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