Provider Demographics
NPI:1972557114
Name:REID, MATHEW CLAYTON (PA)
Entity type:Individual
Prefix:
First Name:MATHEW
Middle Name:CLAYTON
Last Name:REID
Suffix:
Gender:M
Credentials:PA
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 505164
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63150-5164
Mailing Address - Country:US
Mailing Address - Phone:855-420-7900
Mailing Address - Fax:
Practice Address - Street 1:1229 E SEMINOLE ST
Practice Address - Street 2:SUITE 320
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-2227
Practice Address - Country:US
Practice Address - Phone:417-820-2064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004008966363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO667028OtherHEALTHLINK
MO6749504OtherCIGNA HEALTHCARE
MO20814OtherCOX HEALTH PLANS UPI
MO0602000OtherUNITED HEALTHCARE
MO18942OtherCOX HEALTH PLANS
MO502277007Medicaid
MOQ20276OtherUSPS (W/C)
MO190142OtherBLUE CROSS/CHOICE
MO6749504OtherCIGNA HEALTHCARE
MO190142OtherBLUE CROSS/CHOICE
MOQ20276Medicare UPIN
MO000097106Medicare PIN