1598964124 NPI number — W. THOMAS COOMBE, MD , A MEDICAL CORPORATION

Table of content: (NPI 1598964124)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598964124 NPI number — W. THOMAS COOMBE, MD , A MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
W. THOMAS COOMBE, MD , A MEDICAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598964124
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3409
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PAYSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85547-3409
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-468-9280
Provider Business Mailing Address Fax Number:
928-468-9280

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2051 EVERGREEN LN
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
SHOW LOW
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85901-7928
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-537-1042
Provider Business Practice Location Address Fax Number:
928-537-1082
Provider Enumeration Date:
07/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
COOMBE
Authorized Official First Name:
WALTER
Authorized Official Middle Name:
THOMAS
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
928-537-1042

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X , with the licence number:  36942 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 218514 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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