Basic Information
Provider Information | |||||||||
NPI: | 1538299342 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | REID PHYSICIAN ASSOCIATES, INC. | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | FAMILY & OCCUPATIONAL MEDICINE OF LYNN & RIDGEVILLE | ||||||||
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: | 7659358806 | ||||||||
FaxNumber: | 7659833219 | ||||||||
Practice Location | |||||||||
Address1: | 105 E 2ND ST | ||||||||
Address2: |   | ||||||||
City: | RIDGEVILLE | ||||||||
State: | IN | ||||||||
PostalCode: | 473801325 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7658572523 | ||||||||
FaxNumber: | 7658572304 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/07/2007 | ||||||||
LastUpdateDate: | 09/22/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: | 07/22/2015 | ||||||||
NPIReactivationDate: | 09/22/2015 | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | KINYON | ||||||||
AuthorizedOfficialFirstName: | CRAIG | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | PRESIDENT / CEO | ||||||||
AuthorizedOfficialTelephone: | 7659833127 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X |   |   | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |   |
No ID Information.