Provider Demographics
NPI:1376651323
Name:REID, JO R (CRNA)
Entity Type:Individual
Prefix:
First Name:JO
Middle Name:R
Last Name:REID
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9263 MEDICAL PLAZA DRIVE
Mailing Address - Street 2:STE E
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-7112
Mailing Address - Country:US
Mailing Address - Phone:843-572-1228
Mailing Address - Fax:877-561-7564
Practice Address - Street 1:9263 MEDICAL PLAZA DRIVE
Practice Address - Street 2:STE E
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-7112
Practice Address - Country:US
Practice Address - Phone:843-572-1228
Practice Address - Fax:877-561-7564
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1809367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAN1283Medicaid
Q09722Medicare UPIN
SCQ33507Medicare ID - Type Unspecified