Healthcare Provider Details

I. General information

NPI: 1164233698
Provider Name (Legal Business Name): LINDA MCCOMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2025
Last Update Date: 01/15/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 LOOKOUT ROAD
HICO WV
25854
US

IV. Provider business mailing address

PO BOX 34
LOOKOUT WV
25868-0034
US

V. Phone/Fax

Practice location:
  • Phone: 304-880-6063
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: