MEDICARE: MISS SOMER MACKENIZE REID

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246RP1900X	Phlebotomy Technician		OH

General Provider Information

NPI Number	:	1558141366
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS SOMER MACKENIZE REID

Provider Business Mailing Address
First Line	:	55234 NORTHSTAR RD
Second Line	:
City	:	PLEASANT CITY
State	:	OH
Zip	:	43772-9727
Country	:	US
Telephone Number	:	740-995-9858
Fax Number	:

Provider Business Practice Location Address
First Line	:	12835 PLEASANT HILL RD
Second Line	:
City	:	NEW CONCORD
State	:	OH
Zip	:	43762-9782
Country	:	US
Telephone Number	:	740-995-9858
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2023
Last Update Date	:	10/02/2023

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Directions to “ MISS SOMER MACKENIZE REID ” Practice Location

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