Individual
MR. JOHN REIMBOLD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS CCCA
Contact information
Practice address
1717 W MAIN STREET, CARBONDAL, IL 62901
(618) 457-6643
(618) 457-6643
Mailing address
PO BOX 1058, 1717 W MAIN STREET, CARBONDALE, IL 62903-1058
(618) 457-6643
(618) 457-6643
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
147000156
IL
231H00000X
Audiologist
—
—
237700000X
Hearing Instrument Specialist
IDPH0394
IL
332B00000X
Durable Medical Equipment & Medical Supplies
IDPH0394
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
029298
HEALTH ALLIANCE
IL
01
—
3970321
BCBS
IL
Enumeration date
08/11/2006
Last updated
10/06/2022
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