Provider Demographics
NPI:1780947085
Name:MARTHA COMBS WOOLUM MD PLLC
Entity type:Organization
Organization Name:MARTHA COMBS WOOLUM MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:C
Authorized Official - Last Name:COMBS-WOOLUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-337-8119
Mailing Address - Street 1:121 W VIRGINIA AVE
Mailing Address - Street 2:SUITE F200
Mailing Address - City:PINEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40977-1661
Mailing Address - Country:US
Mailing Address - Phone:606-337-8119
Mailing Address - Fax:606-337-9956
Practice Address - Street 1:121 W VIRGINIA AVE
Practice Address - Street 2:SUITE F200
Practice Address - City:PINEVILLE
Practice Address - State:KY
Practice Address - Zip Code:40977-1661
Practice Address - Country:US
Practice Address - Phone:606-337-8119
Practice Address - Fax:606-337-9956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-21
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY26212207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty