Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 016-004885 | IL |
NPI | 1104822691 |
---|---|
Provider Name | Dr. Helena A Reid |
First Address | Moline, IL 61265-8026 |
Second Address | Moline, IL 61265-8026 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2005 |
Last Update Date | 21/06/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
04532384 | BLUE CROSS BLUE SHIELD IL (01) | IL |
139503800 | DEPT OF LABOR (01) | IL |
42117624432 | UNITED HEALTHCARE RV (01) | IL |
480025984 | MEDICARE RAIL ROAD PROVID (01) | IL |
96291 | WELLMARK BCBS PROVIDER # (01) | IA |
K29441 | MC INDIVIDUAL PROVIDER # (01) | IL |
U71566 | (02) | IL |