Provider Demographics
NPI:1154324630
Name:REID PHYSICIAN ASSOCIATES, INC.
Entity Type:Organization
Organization Name:REID PHYSICIAN ASSOCIATES, INC.
Other - Org Name:REID PRIMARY & SPECIALTY CARE - CAMBRIDGE CITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:C
Authorized Official - Last Name:KINYON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-935-8806
Mailing Address - Street 1:1100 REID PKWY
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1157
Mailing Address - Country:US
Mailing Address - Phone:765-478-6108
Mailing Address - Fax:765-478-1243
Practice Address - Street 1:1154 S STATE ROAD 1 STE 1
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE CITY
Practice Address - State:IN
Practice Address - Zip Code:47327-9472
Practice Address - Country:US
Practice Address - Phone:765-478-6108
Practice Address - Fax:765-478-1243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-27
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN15-3896OtherOSCAR
IN201210980Medicaid
INCB0499Medicare ID - Type UnspecifiedTRAVELERS MEDICARE
IN=========-001OtherANTHEM ID NUMBER
IN100256970Medicaid