Provider Demographics
NPI:1942208988
Name:HUNTER-REACH, PAMELA KAY (MD)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:KAY
Last Name:HUNTER-REACH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:KAY
Other - Last Name:REACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 19639
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62794-9639
Mailing Address - Country:US
Mailing Address - Phone:217-545-8000
Mailing Address - Fax:
Practice Address - Street 1:300 W OAK ST
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-1400
Practice Address - Country:US
Practice Address - Phone:618-536-6621
Practice Address - Fax:618-453-1102
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2024-01-29
Deactivation Date:2006-03-31
Deactivation Code:
Reactivation Date:2006-05-01
Provider Licenses
StateLicense IDTaxonomies
IL036-099509207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-099509Medicaid
IL411392OtherHEALTHLINK
ILH05071OtherBLUE CROSS BLUE SHIELD
ILH05071OtherTRICARE
ILP00132466OtherUNITED HEALTHCARE RR MEDI
IL036099509OtherIDPA FEE FOR SERVICE
IL052911OtherHEALTH ALLIANCE
ILH05071OtherCHAMPVA
ILH05071OtherBLUE CROSS BLUE SHIELD
ILK06442Medicare ID - Type Unspecified
IL036-099509Medicaid
IL214859001Medicare PIN
IL036099509OtherIDPA FEE FOR SERVICE