Provider Demographics
NPI:1063492213
Name:COMBS, RICHARD (CRNA)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:COMBS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3518
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67201-3518
Mailing Address - Country:US
Mailing Address - Phone:316-685-6236
Mailing Address - Fax:316-652-0340
Practice Address - Street 1:3601 N WEBB RD
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-8129
Practice Address - Country:US
Practice Address - Phone:316-685-6236
Practice Address - Fax:316-652-0340
Is Sole Proprietor?:No
Enumeration Date:2006-01-21
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS54208367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS103452OtherBCBS
P00154094OtherRAILROAD MEDICARE
KS100247960BMedicaid
P00154094OtherRAILROAD MEDICARE