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General NPI Number Information
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NPI Number | 1538479597
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Entity Type | Organization
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Legal Business Name | COMBS FAMILY PRACTICE OF BULL SHOALS
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Dates
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Enumeration Date | 10/08/2010
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Last Update Date | 10/08/2010
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Provider Practice Location Address
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Address Line | 505 HILLCREST ST
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City | BULL SHOALS
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State | AR
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Zip | 72619-3109
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Country | US
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Telephone | 870-445-3296
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Fax | 870-445-3302
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Provider Business Mailing Address
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Address Line | 505 HILLCREST ST
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City | BULL SHOALS
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State | AR
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Zip | 72619-3109
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Country | US
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Telephone | 870-445-3296
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Fax | 870-445-3302
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Authorized Official
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Title or Position | OWNER
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Name | PROF. KATIE E COMBS
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Credential | APN
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Telephone | 870-445-3296
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | A03025ANP
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License Number State | AR
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