Healthcare Provider Details

I. General information

NPI: 1568085231
Provider Name (Legal Business Name): AUSTIN COMBS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2020
Last Update Date: 05/17/2024
Certification Date: 11/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9556 MANCHESTER RD
SAINT LOUIS MO
63119-1313
US

IV. Provider business mailing address

13861 MANCHESTER RD
BALLWIN MO
63011-4503
US

V. Phone/Fax

Practice location:
  • Phone: 314-373-5740
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2021034019
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: