1982899043 NPI number — ERIC REIMUND MD PA

Table of content: (NPI 1982899043)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982899043 NPI number — ERIC REIMUND MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ERIC REIMUND MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982899043
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 922
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENVILLE
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
38702-0922
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-334-9829
Provider Business Mailing Address Fax Number:
662-334-3529

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1400 E UNION ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENVILLE
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38703-3246
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-378-3783
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
REIMUND
Authorized Official First Name:
ERIC
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER PRESIDENT
Authorized Official Telephone Number:
662-334-9829

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0105X , with the licence number:  14678 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P00454885 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 00115838 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 230928756A . This is a "BLUE CROSS OF MISSISSIPPI" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: DG7903 . This is a "RAILROAD MEDICARE GROUP" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 04879387 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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