Healthcare Provider Details

I. General information

NPI: 1962753319
Provider Name (Legal Business Name): REID PHYSICIAN ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2012
Last Update Date: 09/22/2015
Certification Date:
Deactivation Date: 07/22/2015
Reactivation Date: 09/22/2015

III. Provider practice location address

400 S OAK ST
WINCHESTER IN
47394-2225
US

IV. Provider business mailing address

1100 REID PKWY MEDICAL STAFF SERVICES
RICHMOND IN
47374-1157
US

V. Phone/Fax

Practice location:
  • Phone: 765-584-6600
  • Fax: 765-584-6503
Mailing address:
  • Phone: 765-983-3127
  • Fax: 765-983-3219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: THOMAS HUTH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 765-983-3202