Provider Demographics
NPI:1295368124
Name:GA COMBINE LLC
Entity Type:Organization
Organization Name:GA COMBINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUKHARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-570-0622
Mailing Address - Street 1:1338 3RD AVE NW LOT 136
Mailing Address - Street 2:
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-2274
Mailing Address - Country:US
Mailing Address - Phone:515-570-0622
Mailing Address - Fax:
Practice Address - Street 1:1338 3RD AVE NW LOT 136
Practice Address - Street 2:
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-2274
Practice Address - Country:US
Practice Address - Phone:515-570-0622
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-19
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)