Provider Demographics
NPI:1851892889
Name:REID, PATRICIA E
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:E
Last Name:REID
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:739 FOUNTAIN LAKE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29209-5712
Mailing Address - Country:US
Mailing Address - Phone:803-673-9561
Mailing Address - Fax:
Practice Address - Street 1:739 FOUNTAIN LAKE RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29209-5712
Practice Address - Country:US
Practice Address - Phone:803-673-9561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-25
Last Update Date:2018-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCEXG300OtherCLTC
SCEA3819Medicaid