Basic Information
Provider Information | |||||||||
NPI: | 1639376932 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | JOHN L. REED M.D. SURGICAL PRACTICE, P.C. | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 8055 O STREET | ||||||||
Address2: | SUITE 300 | ||||||||
City: | LINCOLN | ||||||||
State: | NE | ||||||||
PostalCode: | 685102580 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4024210896 | ||||||||
FaxNumber: | 4024210945 | ||||||||
Practice Location | |||||||||
Address1: | 8055 O ST | ||||||||
Address2: | SUITE 300 | ||||||||
City: | LINCOLN | ||||||||
State: | NE | ||||||||
PostalCode: | 685102564 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4024210896 | ||||||||
FaxNumber: | 4024210945 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/29/2007 | ||||||||
LastUpdateDate: | 04/20/2008 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | REED | ||||||||
AuthorizedOfficialFirstName: | JOHN | ||||||||
AuthorizedOfficialMiddleName: | L | ||||||||
AuthorizedOfficialTitleorPosition: | PRESIDENT & OWNER | ||||||||
AuthorizedOfficialTelephone: | 4024831991 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | MD | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 10719 | NE | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |   |
ID Information
ID | Type | State | Issuer | Description | 1700437 | 01 | NE | UHC | OTHER | 0591669 | 05 | IA |   | MEDICAID | 7719030 | 05 | SD |   | MEDICAID | 10025532000 | 05 | NE |   | MEDICAID | 1226 | 01 | NE | MIDLANDS CHOICE | OTHER | 35824 | 01 | NE | BCBS | OTHER |