Healthcare Provider Details

I. General information

NPI: 1821193525
Provider Name (Legal Business Name): JOSEPH R. REED P.A.-C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 06/07/2021
Certification Date: 06/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 TRILLIUM WAY LOWR LEVEL
CORBIN KY
40701-8426
US

IV. Provider business mailing address

5224 75TH ST STE D
LUBBOCK TX
79424-2525
US

V. Phone/Fax

Practice location:
  • Phone: 270-575-2100
  • Fax: 270-415-7229
Mailing address:
  • Phone: 806-712-1096
  • Fax: 806-771-2093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA0000000899
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA660
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: