Provider Demographics
NPI:1942585963
Name:HERMAN L. REID III MD LLC
Entity Type:Organization
Organization Name:HERMAN L. REID III MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:PENN-REID
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:812-306-6631
Mailing Address - Street 1:18920 ROSCOMMON RD
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47725-6417
Mailing Address - Country:US
Mailing Address - Phone:812-306-6631
Mailing Address - Fax:812-867-6951
Practice Address - Street 1:7839 S PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:FORT BRANCH
Practice Address - State:IN
Practice Address - Zip Code:47648-8405
Practice Address - Country:US
Practice Address - Phone:812-306-6631
Practice Address - Fax:812-867-6951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-21
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01056394A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200389450Medicaid
IN201228280Medicaid
ILXXXXX3397Medicaid
IN237890SMedicare PIN
IN200389450Medicaid
INC29859Medicare UPIN