Provider Demographics
NPI:1730175613
Name:REID, ANN E (PAC)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:E
Last Name:REID
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 148
Mailing Address - Street 2:909 WEST FIRST STREET
Mailing Address - City:SUMNER
Mailing Address - State:IA
Mailing Address - Zip Code:50674-0148
Mailing Address - Country:US
Mailing Address - Phone:563-578-3275
Mailing Address - Fax:563-578-3279
Practice Address - Street 1:909 W 1ST ST
Practice Address - Street 2:
Practice Address - City:SUMNER
Practice Address - State:IA
Practice Address - Zip Code:50674-1203
Practice Address - Country:US
Practice Address - Phone:563-578-3279
Practice Address - Fax:563-578-3279
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1115207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA970031149OtherRR MEDICARE
IAI8385Medicare PIN
IA970031149OtherRR MEDICARE