Provider Demographics
NPI:1699038521
Name:REED MEDICAL CLINIC
Entity Type:Organization
Organization Name:REED MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN-OWNER-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALPHONSE
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-445-7352
Mailing Address - Street 1:55 SGT PRENTISS DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-4782
Mailing Address - Country:US
Mailing Address - Phone:601-445-7352
Mailing Address - Fax:601-445-7353
Practice Address - Street 1:55 SGT PRENTISS DR
Practice Address - Street 2:SUITE 102
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-4782
Practice Address - Country:US
Practice Address - Phone:601-445-7352
Practice Address - Fax:601-445-7353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS10009261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00013542Medicaid
MS110000144Medicare PIN
MS00013542Medicaid