Healthcare Provider Details

I. General information

NPI: 1972557114
Provider Name (Legal Business Name): MATHEW CLAYTON REID P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 01/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1229 E SEMINOLE ST SUITE 320
SPRINGFIELD MO
65804-2227
US

IV. Provider business mailing address

PO BOX 505164
SAINT LOUIS MO
63150-5164
US

V. Phone/Fax

Practice location:
  • Phone: 417-820-2064
  • Fax:
Mailing address:
  • Phone: 855-420-7900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number2004008966
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier667028
Identifier TypeOTHER
Identifier StateMO
Identifier IssuerHEALTHLINK
# 2
Identifier6749504
Identifier TypeOTHER
Identifier StateMO
Identifier IssuerCIGNA HEALTHCARE
# 3
Identifier20814
Identifier TypeOTHER
Identifier StateMO
Identifier IssuerCOX HEALTH PLANS UPI
# 4
Identifier0602000
Identifier TypeOTHER
Identifier StateMO
Identifier IssuerUNITED HEALTHCARE
# 5
Identifier18942
Identifier TypeOTHER
Identifier StateMO
Identifier IssuerCOX HEALTH PLANS
# 6
Identifier502277007
Identifier TypeMEDICAID
Identifier StateMO
Identifier Issuer
# 7
IdentifierQ20276
Identifier TypeOTHER
Identifier StateMO
Identifier IssuerUSPS (W/C)
# 8
Identifier190142
Identifier TypeOTHER
Identifier StateMO
Identifier IssuerBLUE CROSS/CHOICE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: