Provider Demographics
NPI:1043016264
Name:REYNOLDS, IVO VICTOR III
Entity type:Individual
Prefix:
First Name:IVO
Middle Name:VICTOR
Last Name:REYNOLDS
Suffix:III
Gender:
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 900
Mailing Address - Street 2:
Mailing Address - City:CHADRON
Mailing Address - State:NE
Mailing Address - Zip Code:69337-0900
Mailing Address - Country:US
Mailing Address - Phone:308-432-4050
Mailing Address - Fax:
Practice Address - Street 1:5789 HIGHWAY 20
Practice Address - Street 2:
Practice Address - City:CHADRON
Practice Address - State:NE
Practice Address - Zip Code:69337-7349
Practice Address - Country:US
Practice Address - Phone:308-432-4050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-19
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker