Basic Information
| Provider Information | |||||||||
| NPI: | 1437223146 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | REED | ||||||||
| FirstName: | JONATHAN | ||||||||
| MiddleName: | JUDE | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 75 REMIT DRIVE | ||||||||
| Address2: | LOCKBOX 1940 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606751940 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8669165255 | ||||||||
| FaxNumber: | 2319224030 | ||||||||
| Practice Location | |||||||||
| Address1: | 10 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | SAINT PETERS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 633761659 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3145251900 | ||||||||
| FaxNumber: | 3145254868 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2006 | ||||||||
| LastUpdateDate: | 05/26/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 2002008841 | MO | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 215050155 | 01 | CPIN @ ST ANTHONYS | OTHER | 1437223146 | 05 | MO | MEDICAID | 206271801 | 05 | MO | MEDICAID |