=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720496367
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REESE FIRST ASSISTING, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/28/2014
-----------------------------------------------------
Last Update Date | 09/22/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6610 BROOKS DR
-----------------------------------------------------
City | TEMPLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76502-6301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 254-289-2858
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6610 BROOKS DR
-----------------------------------------------------
City | TEMPLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76502-6301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 254-289-2858
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | BARRY REESE
-----------------------------------------------------
Credential | LSA
-----------------------------------------------------
Telephone | 254-289-2858
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 246ZC0007X
-----------------------------------------------------
Taxonomy Name | Surgical Assistant
-----------------------------------------------------
License Number | SA00573
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------