Provider Demographics
NPI:1396851200
Name:THOMAS E ACOMB MD A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:THOMAS E ACOMB MD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:EVERETT
Authorized Official - Last Name:ACOMB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-622-8700
Mailing Address - Street 1:191FIFTH STREET WEST
Mailing Address - Street 2:P O BOX 8880
Mailing Address - City:KETCHUM
Mailing Address - State:ID
Mailing Address - Zip Code:83340-7139
Mailing Address - Country:US
Mailing Address - Phone:208-622-8700
Mailing Address - Fax:208-725-2015
Practice Address - Street 1:191 FIFTH STREET WEST
Practice Address - Street 2:
Practice Address - City:KETCHUM
Practice Address - State:ID
Practice Address - Zip Code:83340-7139
Practice Address - Country:US
Practice Address - Phone:208-622-8700
Practice Address - Fax:208-725-2015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM9289207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty