Provider Demographics
NPI:1508870585
Name:JOHN REIMBOLD
Entity Type:Organization
Organization Name:JOHN REIMBOLD
Other - Org Name:CARBONDALE HEARING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-457-6643
Mailing Address - Street 1:PO BOX 1058
Mailing Address - Street 2:1717 W MAIN STREET
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62903-1058
Mailing Address - Country:US
Mailing Address - Phone:618-457-6643
Mailing Address - Fax:618-457-6643
Practice Address - Street 1:1717 W MAIN STREET
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901
Practice Address - Country:US
Practice Address - Phone:618-457-6643
Practice Address - Fax:618-457-6643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147000156231H00000X
IL147001158231H00000X
IL147000788231H00000X
231H00000X
IL0394237700000X
IL2354332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL359446176001Medicaid
IL205218Medicare ID - Type Unspecified