Healthcare Provider Details

I. General information

NPI: 1548336662
Provider Name (Legal Business Name): REID ALAN MATTESON C. PED.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 S VAN EPS AVE
SIOUX FALLS SD
57103-1734
US

IV. Provider business mailing address

112 S VAN EPS AVE
SIOUX FALLS SD
57103-1734
US

V. Phone/Fax

Practice location:
  • Phone: 605-331-3067
  • Fax: 605-331-3083
Mailing address:
  • Phone: 605-331-3067
  • Fax: 605-331-3083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: