Provider Demographics
NPI:1922859750
Name:DOCTOR REID BLLC
Entity Type:Organization
Organization Name:DOCTOR REID BLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REID
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBISON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-839-5227
Mailing Address - Street 1:1788 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-2025
Mailing Address - Country:US
Mailing Address - Phone:801-839-5227
Mailing Address - Fax:801-749-4098
Practice Address - Street 1:1788 N STATE ST
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-2025
Practice Address - Country:US
Practice Address - Phone:801-839-5227
Practice Address - Fax:801-749-4098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-29
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)