Healthcare Provider Details

I. General information

NPI: 1922383074
Provider Name (Legal Business Name): SCOTT A REED MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2011
Last Update Date: 05/12/2021
Certification Date: 05/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 S DIVISION ST
PINEHURST ID
83850-9767
US

IV. Provider business mailing address

9 MAIN ST UNIT 894
PINEHURST ID
83850-1435
US

V. Phone/Fax

Practice location:
  • Phone: 208-682-9200
  • Fax: 208-682-9300
Mailing address:
  • Phone: 208-682-2707
  • Fax: 208-682-3108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberM8355
License Number StateID

VIII. Authorized Official

Name: DR. SCOTT A REED
Title or Position: PROVIDER/OWNER
Credential: MD PC
Phone: 208-682-9200