Provider Demographics
NPI:1538479597
Name:COMBS FAMILY PRACTICE OF BULL SHOALS
Entity Type:Organization
Organization Name:COMBS FAMILY PRACTICE OF BULL SHOALS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:PROF
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:COMBS
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:870-445-3296
Mailing Address - Street 1:505 HILLCREST ST
Mailing Address - Street 2:
Mailing Address - City:BULL SHOALS
Mailing Address - State:AR
Mailing Address - Zip Code:72619-3109
Mailing Address - Country:US
Mailing Address - Phone:870-445-3296
Mailing Address - Fax:870-445-3302
Practice Address - Street 1:505 HILLCREST ST
Practice Address - Street 2:
Practice Address - City:BULL SHOALS
Practice Address - State:AR
Practice Address - Zip Code:72619-3109
Practice Address - Country:US
Practice Address - Phone:870-445-3296
Practice Address - Fax:870-445-3302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-08
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA03025ANP261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5A873Medicare UPIN