Healthcare Provider Details

I. General information

NPI: 1851892889
Provider Name (Legal Business Name): PATRICIA E REID
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2018
Last Update Date: 02/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

739 FOUNTAIN LAKE RD
COLUMBIA SC
29209-5712
US

IV. Provider business mailing address

739 FOUNTAIN LAKE RD
COLUMBIA SC
29209-5712
US

V. Phone/Fax

Practice location:
  • Phone: 803-673-9561
  • Fax:
Mailing address:
  • Phone: 803-673-9561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: