Provider Demographics
NPI:1720380280
Name:ALICE J. REED, PA
Entity Type:Organization
Organization Name:ALICE J. REED, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:PARISEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-249-6556
Mailing Address - Street 1:357 11TH AVE S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-5153
Mailing Address - Country:US
Mailing Address - Phone:904-249-6556
Mailing Address - Fax:904-270-2263
Practice Address - Street 1:357 11TH AVE S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-5153
Practice Address - Country:US
Practice Address - Phone:904-249-6556
Practice Address - Fax:904-270-2263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-03
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE91540Medicare UPIN