Provider Demographics
NPI:1982899043
Name:ERIC REIMUND MD PA
Entity Type:Organization
Organization Name:ERIC REIMUND MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:REIMUND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-334-9829
Mailing Address - Street 1:PO BOX 922
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38702-0922
Mailing Address - Country:US
Mailing Address - Phone:662-334-9829
Mailing Address - Fax:662-334-3529
Practice Address - Street 1:1400 E UNION ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38703-3246
Practice Address - Country:US
Practice Address - Phone:662-378-3783
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS14678207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSP00454885OtherRAILROAD MEDICARE
MS00115838Medicaid
MS230928756AOtherBLUE CROSS OF MISSISSIPPI
MSDG7903OtherRAILROAD MEDICARE GROUP
MS04879387Medicaid
MS512I220001Medicare PIN
MS00115838Medicaid