Provider Demographics
NPI:1194904326
Name:REED M. BOUCHEY, M.D., P.C.
Entity type:Organization
Organization Name:REED M. BOUCHEY, M.D., P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:REED
Authorized Official - Middle Name:MUNRO
Authorized Official - Last Name:BOUCHEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PC
Authorized Official - Phone:319-385-6775
Mailing Address - Street 1:501 S WHITE ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:IA
Mailing Address - Zip Code:52641-2600
Mailing Address - Country:US
Mailing Address - Phone:319-385-6775
Mailing Address - Fax:319-385-6778
Practice Address - Street 1:501 S WHITE ST
Practice Address - Street 2:SUITE 105
Practice Address - City:MOUNT PLEASANT
Practice Address - State:IA
Practice Address - Zip Code:52641-2600
Practice Address - Country:US
Practice Address - Phone:319-385-6775
Practice Address - Fax:319-385-6778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA26041261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA12294OtherBLUE SHIELD
IA372521983526410000OtherTRICARE
IA0100297Medicaid
IA0100297Medicaid