Provider Demographics
NPI:1871645721
Name:MCCOMB GOINS, STACY (PAC)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:MCCOMB GOINS
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:
Other - Last Name:MCCOMB JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 35100
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59107-5100
Mailing Address - Country:US
Mailing Address - Phone:406-238-2500
Mailing Address - Fax:
Practice Address - Street 1:801 N 29TH ST
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-0905
Practice Address - Country:US
Practice Address - Phone:406-238-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT121363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0109876OtherMDCD PIN
MT000091363OtherBCBS PIN
WY103644100OtherMDCD PIN
MT000091363OtherBCBS PIN
MTR97092Medicare UPIN
MT000081016Medicare PIN
MT0109876OtherMDCD PIN
MT970007659Medicare PIN