1881878163 NPI number — DIANE L COMBS MD PS

Table of content: (NPI 1881878163)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881878163 NPI number — DIANE L COMBS MD PS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIANE L COMBS MD PS
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:
1881878163
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/22/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4700 POINT FOSDICK DR NW
Provider Second Line Business Mailing Address:
SUITE 208
Provider Business Mailing Address City Name:
GIG HARBOR
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98335-1706
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-851-3992
Provider Business Mailing Address Fax Number:
253-851-4310

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4700 POINT FOSDICK DR NW
Provider Second Line Business Practice Location Address:
SUITE 208
Provider Business Practice Location Address City Name:
GIG HARBOR
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98335-1706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-851-3992
Provider Business Practice Location Address Fax Number:
253-851-4310
Provider Enumeration Date:
12/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
COMBS
Authorized Official First Name:
DIANE
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
253-851-3992

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  602343242 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1004522 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0150158 . This is a "LABOR & INDUSTRIES" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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