Provider Demographics
NPI:1487838967
Name:REEDER GASTROENTEROLOGY PC
Entity Type:Organization
Organization Name:REEDER GASTROENTEROLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALTON
Authorized Official - Middle Name:A
Authorized Official - Last Name:REEDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-883-3993
Mailing Address - Street 1:624 QUAKER LN
Mailing Address - Street 2:SUITE D201
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-3832
Mailing Address - Country:US
Mailing Address - Phone:336-883-3993
Mailing Address - Fax:336-884-3401
Practice Address - Street 1:624 QUAKER LN
Practice Address - Street 2:SUITE D201
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-3832
Practice Address - Country:US
Practice Address - Phone:336-883-3993
Practice Address - Fax:336-884-3401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-20
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13534207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89045RGMedicaid
NCC80826Medicare UPIN
NC89045RGMedicaid