Provider Demographics
NPI:1356494272
Name:EDWARD H NEWCOMBE
Entity Type:Organization
Organization Name:EDWARD H NEWCOMBE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE/BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:VALORY
Authorized Official - Last Name:CARLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-375-0722
Mailing Address - Street 1:2036 N COLE RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-7309
Mailing Address - Country:US
Mailing Address - Phone:208-375-0722
Mailing Address - Fax:
Practice Address - Street 1:2036 N COLE RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-7309
Practice Address - Country:US
Practice Address - Phone:208-375-0722
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM2849302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID001117802Medicaid
ID1376791Medicare PIN
ID001117802Medicaid
IDB63502Medicare UPIN