Provider Demographics
NPI:1164024659
Name:REESE, SCOTT (PARAMEDIC)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:REESE
Suffix:
Gender:M
Credentials:PARAMEDIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 CANAL BLVD APT 11
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-1749
Mailing Address - Country:US
Mailing Address - Phone:785-650-1045
Mailing Address - Fax:
Practice Address - Street 1:2800 CANAL BLVD APT 11
Practice Address - Street 2:
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-1749
Practice Address - Country:US
Practice Address - Phone:785-650-1045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
M0939140146L00000X
KS27770146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
M0939140OtherNATIONAL REGISTRY OF EMTS
KS27770OtherKANSAS BOARD OF EMS