Provider Demographics
NPI:1841341047
Name:JOHN W. REIS
Entity type:Organization
Organization Name:JOHN W. REIS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST, OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:REIS
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:515-432-8534
Mailing Address - Street 1:724 ALLEN ST
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:IA
Mailing Address - Zip Code:50036-2929
Mailing Address - Country:US
Mailing Address - Phone:515-432-8534
Mailing Address - Fax:515-432-8631
Practice Address - Street 1:724 ALLEN ST
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:IA
Practice Address - Zip Code:50036-2929
Practice Address - Country:US
Practice Address - Phone:515-432-8534
Practice Address - Fax:515-432-8631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00508237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0051755Medicare ID - Type Unspecified
IA27059Medicare ID - Type Unspecified