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General NPI Number Information
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NPI Number | 1396851200
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Entity Type | Organization
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Legal Business Name | THOMAS E ACOMB MD A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 08/22/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 191 FIFTH STREET WEST
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City | KETCHUM
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State | ID
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Zip | 83340-7139
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Country | US
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Telephone | 208-622-8700
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Fax | 208-725-2015
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Provider Business Mailing Address
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Address Line | 191FIFTH STREET WEST P O BOX 8880
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City | KETCHUM
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State | ID
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Zip | 83340-7139
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Country | US
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Telephone | 208-622-8700
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Fax | 208-725-2015
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. THOMAS EVERETT ACOMB
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Credential | MD
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Telephone | 208-622-8700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | M9289
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License Number State | ID
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