Provider Demographics
NPI:1134193410
Name:REID PHYSICIAN ASSOCIATES, INC.
Entity type:Organization
Organization Name:REID PHYSICIAN ASSOCIATES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:C
Authorized Official - Last Name:KINYON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-983-3122
Mailing Address - Street 1:1100 REID PARKWAY, MEDICAL STAFF SERVICES
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-5547
Mailing Address - Country:US
Mailing Address - Phone:765-966-1600
Mailing Address - Fax:765-962-9641
Practice Address - Street 1:101 S 10TH ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-5547
Practice Address - Country:US
Practice Address - Phone:765-966-1600
Practice Address - Fax:765-962-9641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-14
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0174056Medicaid
IN201041300Medicaid
OH0174056Medicaid
IN201041300Medicaid