Healthcare Provider Details

I. General information

NPI: 1679271100
Provider Name (Legal Business Name): REID PHYSICIAN ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2023
Last Update Date: 02/23/2023
Certification Date: 02/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11051 STATE ROAD 101 STE B
BROOKVILLE IN
47012-0018
US

IV. Provider business mailing address

1100 REID PKWY
RICHMOND IN
47374-1157
US

V. Phone/Fax

Practice location:
  • Phone: 765-647-7623
  • Fax: 765-647-7624
Mailing address:
  • Phone: 765-983-3127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MISTY NASH
Title or Position: DIRECTOR
Credential:
Phone: 765-983-3127