Provider Demographics
NPI:1043402753
Name:MARY REAMS MD
Entity type:Organization
Organization Name:MARY REAMS MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:STONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-329-0799
Mailing Address - Street 1:PO BOX 2057
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-2057
Mailing Address - Country:US
Mailing Address - Phone:606-329-0799
Mailing Address - Fax:606-329-0947
Practice Address - Street 1:2430 WINCHESTER AVE STE B
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7879
Practice Address - Country:US
Practice Address - Phone:606-329-0799
Practice Address - Fax:606-329-0947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-16
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY20802207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64208028Medicaid
KY5484Medicare PIN
KY64208028Medicaid