MEDICARE: REAGAN REID ENTERPRISE INC

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	367A00000X	Advanced Practice Midwife	AP124122	TX

General Provider Information

NPI Number	:	1578926390
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REAGAN REID ENTERPRISE INC

Provider Business Mailing Address
First Line	:	7453 LAS COLINAS BLVD
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75063-7561
Country	:	US
Telephone Number	:	972-215-6934
Fax Number	:	972-607-9254

Provider Business Practice Location Address
First Line	:	7453 LAS COLINAS BLVD
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75063-7561
Country	:	US
Telephone Number	:	972-215-6934
Fax Number	:	972-607-9254

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	MRS. TRACI L SANTANGELO
Credential	:
Telephone Number	:	972-215-6934

Provider Enumeration Date	:	03/30/2016
Last Update Date	:	03/21/2025

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