Provider Demographics
NPI:1578275335
Name:EQUITY CLINIC S.C.
Entity Type:Organization
Organization Name:EQUITY CLINIC S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:REISINGER-KINDLE
Authorized Official - Suffix:
Authorized Official - Credentials:DO, MPH, MS
Authorized Official - Phone:269-929-1064
Mailing Address - Street 1:2111 W PARK CT
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61821-2986
Mailing Address - Country:US
Mailing Address - Phone:224-350-2973
Mailing Address - Fax:
Practice Address - Street 1:2111 W PARK CT
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61821-2986
Practice Address - Country:US
Practice Address - Phone:269-929-1064
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-22
Last Update Date:2023-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty