Basic Information
| Provider Information | |||||||||
| NPI: | 1982899043 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ERIC REIMUND MD PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 922 | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | MS | ||||||||
| PostalCode: | 387020922 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6623349829 | ||||||||
| FaxNumber: | 6623343529 | ||||||||
| Practice Location | |||||||||
| Address1: | 1400 E UNION ST | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | MS | ||||||||
| PostalCode: | 387033246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6623783783 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2007 | ||||||||
| LastUpdateDate: | 06/04/2008 | ||||||||
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| AuthorizedOfficialLastName: | REIMUND | ||||||||
| AuthorizedOfficialFirstName: | ERIC | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6623349829 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0105X | 14678 | MS | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Clinical Pathology/Laboratory Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00454885 | 01 | MS | RAILROAD MEDICARE | OTHER | 00115838 | 05 | MS | MEDICAID | 230928756A | 01 | MS | BLUE CROSS OF MISSISSIPPI | OTHER | DG7903 | 01 | MS | RAILROAD MEDICARE GROUP | OTHER | 04879387 | 05 | MS | MEDICAID |