Basic Information
| Provider Information | |||||||||
| NPI: | 1588626576 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | REED | ||||||||
| FirstName: | CRYSTAL | ||||||||
| MiddleName: | D. | ||||||||
| NamePrefix: | MS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 906 S HEBRON AVE | ||||||||
| Address2: | |||||||||
| City: | EVANSVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 477144079 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8124761367 | ||||||||
| FaxNumber: | 8124774153 | ||||||||
| Practice Location | |||||||||
| Address1: | 700 N BURKHARDT RD | ||||||||
| Address2: | |||||||||
| City: | EVANSVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 477152740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8124741110 | ||||||||
| FaxNumber: | 8124741303 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | 01042351 | IN | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | 64877368 | 05 | KS | MEDICAID |