Provider Demographics
NPI:1720378128
Name:GALAHADD'S QUEST LLC
Entity Type:Organization
Organization Name:GALAHADD'S QUEST LLC
Other - Org Name:REICHARDT FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:REICHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:419-331-2273
Mailing Address - Street 1:2440 BATON ROUGE
Mailing Address - Street 2:SUITE 306
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805-5104
Mailing Address - Country:US
Mailing Address - Phone:419-331-2273
Mailing Address - Fax:419-331-4274
Practice Address - Street 1:2440 BATON ROUGE
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805-5104
Practice Address - Country:US
Practice Address - Phone:419-331-2273
Practice Address - Fax:419-331-4274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-19
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA10079-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0B51149OtherBCBS-OH
A503JREICHART:80561OtherPERSE ESN
6268010001OtherMEDICARE DME
H006310OtherMEDICARE PTAN
OH0B51149Medicaid
A503JREICHART:80561OtherPERSE ESN
H006310OtherMEDICARE PTAN