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General NPI Number Information
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NPI Number | 1508152117
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Entity Type | Individual
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Provider Name | EVAN A. REIMBOLD HEARING INSTRUMENT D
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Gender | Male
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Dates
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Enumeration Date | 06/22/2011
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Last Update Date | 06/22/2011
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Provider Practice Location Address
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Address Line | 1717 W. MAIN STREET
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City | CARBENDALE
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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 | P.O. BOX 1058 1717 W. MAIN STREET
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City | CARBENDALE
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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 | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | 3009
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License Number State | IL
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