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NPI Code Detail

MEDICARE: KENNETH G COMBS M.D.

MEDICARE: KENNETH G COMBS M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician01042412AIN

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2P00386083OTHERINRR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000109178OTHERINBCBS PIN
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4000000504772OTHERINBCBS - LPI

General Provider Information

NPI Number : 1619971942
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENNETH G COMBS M.D.
Provider Business Mailing Address
First Line : PO BOX 1510
Second Line :
City : EVANSVILLE
State : IN
Zip : 47706-1510
Country : US
Telephone Number : 812-450-6815
Fax Number : 812-842-3480
Provider Business Practice Location Address
First Line : 4015 GATEWAY BLVD
Second Line :
City : NEWBURGH
State : IN
Zip : 47630-8925
Country : US
Telephone Number : 812-858-6244
Fax Number : 812-842-3480
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/31/2005
Last Update Date : 12/10/2015

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Directions to “ KENNETH G COMBS M.D.” Practice Location

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