Provider Demographics
NPI:1316530611
Name:REIS, LUIS G
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:G
Last Name:REIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 501
Mailing Address - Street 2:
Mailing Address - City:MOROCCO
Mailing Address - State:IN
Mailing Address - Zip Code:47963-0501
Mailing Address - Country:US
Mailing Address - Phone:219-669-1206
Mailing Address - Fax:
Practice Address - Street 1:112 E STATE ST
Practice Address - Street 2:
Practice Address - City:MOROCCO
Practice Address - State:IN
Practice Address - Zip Code:47963-7500
Practice Address - Country:US
Practice Address - Phone:219-669-1206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-17
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1420-47-0980343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)