Provider Demographics
NPI:1588844146
Name:JOHN L REYNOLDS MD, PC
Entity Type:Organization
Organization Name:JOHN L REYNOLDS MD, PC
Other - Org Name:ORTHOPAEDIC ASSOCIATES OF MORGAN COUNTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:L
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:765-342-5541
Mailing Address - Street 1:2200 JOHN R WOODEN DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MARTINSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46151-1863
Mailing Address - Country:US
Mailing Address - Phone:765-342-5541
Mailing Address - Fax:765-349-0178
Practice Address - Street 1:2200 JOHN R WOODEN DR
Practice Address - Street 2:SUITE 100
Practice Address - City:MARTINSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46151-1863
Practice Address - Country:US
Practice Address - Phone:765-342-5541
Practice Address - Fax:765-349-0178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-12
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01023979207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INC25383Medicare UPIN
IN561630Medicare PIN