Provider Demographics
NPI:1073819041
Name:ALLAN L. REID PSC
Entity Type:Organization
Organization Name:ALLAN L. REID PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:REID
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:812-471-9926
Mailing Address - Street 1:4828 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-4110
Mailing Address - Country:US
Mailing Address - Phone:812-471-9926
Mailing Address - Fax:182-471-9928
Practice Address - Street 1:4828 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-4110
Practice Address - Country:US
Practice Address - Phone:812-471-9926
Practice Address - Fax:182-471-9928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-08
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12008873A261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200267070Medicaid
1336137926Medicare NSC
U28315Medicare UPIN