Provider Demographics
NPI:1851332209
Name:REID, WILLIAM F (CRNA)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:F
Last Name:REID
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 HWY 82 WEST
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:38930
Mailing Address - Country:US
Mailing Address - Phone:662-455-4523
Mailing Address - Fax:662-455-3790
Practice Address - Street 1:2005 HWY 82 WEST
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:MS
Practice Address - Zip Code:38930
Practice Address - Country:US
Practice Address - Phone:662-455-4523
Practice Address - Fax:662-455-3790
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR792327367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00116958Medicaid
MS331003463OtherTAX ID#
MS640901082OtherTAX ID#
MS430078861OtherRAILROAD MEDICARE
MS430078861OtherRAILROAD MEDICARE
MS331003463OtherTAX ID#
MS00116958Medicaid