MEDICARE: REID PHYSICIAN ASSOCIATES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0200X	Radiology Clinic/Center

General Provider Information

NPI Number	:	1689286973
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REID PHYSICIAN ASSOCIATES INC

Provider Business Mailing Address
First Line	:	1100 REID PKWY
Second Line	:
City	:	RICHMOND
State	:	IN
Zip	:	47374-1157
Country	:	US
Telephone Number	:	765-478-4503
Fax Number	:	765-478-4504

Provider Business Practice Location Address
First Line	:	1154 S STATE ROAD 1 STE 2
Second Line	:
City	:	CAMBRIDGE CITY
State	:	IN
Zip	:	47327-9513
Country	:	US
Telephone Number	:	765-478-4503
Fax Number	:	765-478-4504

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MISTY NASH
Credential	:	CPCS
Telephone Number	:	765-983-3127

Provider Enumeration Date	:	08/19/2020
Last Update Date	:	08/19/2020

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