Provider Demographics
NPI:1346370392
Name:REID PHYSICIAN ASSOCIATES, INC.
Entity Type:Organization
Organization Name:REID PHYSICIAN ASSOCIATES, INC.
Other - Org Name:FAMILY & OCCUPATIONAL MEDICINE OF LYNN & RIDGEVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:KINYON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-983-3127
Mailing Address - Street 1:1100 REID PKWY
Mailing Address - Street 2:MEDICAL STAFF SERVICES
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1157
Mailing Address - Country:US
Mailing Address - Phone:765-874-2390
Mailing Address - Fax:765-874-1721
Practice Address - Street 1:428 S MAIN ST
Practice Address - Street 2:BOX 5
Practice Address - City:LYNN
Practice Address - State:IN
Practice Address - Zip Code:47355-9089
Practice Address - Country:US
Practice Address - Phone:765-874-2390
Practice Address - Fax:765-874-1721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2015-09-22
Deactivation Date:2015-07-22
Deactivation Code:
Reactivation Date:2015-09-22
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN259370Medicare PIN
IN200856750Medicaid
IN15-3889OtherOSCAR
ING13379Medicare UPIN