Provider Demographics
NPI:1225348626
Name:KEVIN M REID D O INC
Entity Type:Organization
Organization Name:KEVIN M REID D O INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:REID
Authorized Official - Suffix:
Authorized Official - Credentials:D O
Authorized Official - Phone:937-226-7887
Mailing Address - Street 1:425 W GRAND AVE
Mailing Address - Street 2:SUITE 2001
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45405-4775
Mailing Address - Country:US
Mailing Address - Phone:937-226-7887
Mailing Address - Fax:937-224-5098
Practice Address - Street 1:425 W GRAND AVE
Practice Address - Street 2:SUITE 2001
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45405-4775
Practice Address - Country:US
Practice Address - Phone:937-226-7887
Practice Address - Fax:937-224-5098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-19
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34002459R261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0396076Medicaid
OH1073514709OtherNPI
OH0396076Medicaid