Provider Demographics
NPI:1306044599
Name:REED I. WARD, D.O., P.A.
Entity Type:Organization
Organization Name:REED I. WARD, D.O., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REED
Authorized Official - Middle Name:IVOL
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:208-528-8170
Mailing Address - Street 1:3360 WASHINGTON PKWY STE 2
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-8333
Mailing Address - Country:US
Mailing Address - Phone:208-528-8170
Mailing Address - Fax:208-522-5461
Practice Address - Street 1:3425 POTOMAC WAY
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-4984
Practice Address - Country:US
Practice Address - Phone:208-528-8170
Practice Address - Fax:208-522-5461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDO-263207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010138476OtherREGENCE BLUE SHIELD OF ID
ID8N464OtherBLUE CROSS OF IDAHO
ID080184962OtherRAILROAD MEDICARE
ID806385700Medicaid
ID806385700Medicaid