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General NPI Number Information
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NPI Number | 1427069541
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Entity Type | Individual
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Provider Name | JOHN REIMBOLD MS CCCA
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Gender | Male
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Dates
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Enumeration Date | 08/11/2006
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Last Update Date | 10/06/2022
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Provider Practice Location Address
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Address Line | 1717 W MAIN STREET
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City | CARBONDAL
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State | IL
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Zip | 62901
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Country | US
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Telephone | 618-457-6643
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Fax | 618-457-6643
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Provider Business Mailing Address
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Address Line | PO BOX 1058 1717 W MAIN STREET
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City | CARBONDALE
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State | IL
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Zip | 62903-1058
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Country | US
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Telephone | 618-457-6643
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Fax | 618-457-6643
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | IDPH0394
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | IDPH0394
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 147000156
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License Number State | IL
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