Healthcare Provider Details

I. General information

NPI: 1003229998
Provider Name (Legal Business Name): BRIAN T. REID PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2014
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 W MEADOW DR STE 400
VAIL CO
81657-5058
US

IV. Provider business mailing address

1700 OLD GATESBURG RD STE 200
STATE COLLEGE PA
16803-2276
US

V. Phone/Fax

Practice location:
  • Phone: 970-476-1100
  • Fax:
Mailing address:
  • Phone: 814-237-4321
  • Fax: 814-235-0484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberOA003361
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: