Provider Demographics
NPI:1023500360
Name:DKMCOMBER CLINICAL SERVICES
Entity type:Organization
Organization Name:DKMCOMBER CLINICAL SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:MCOMBER
Authorized Official - Suffix:
Authorized Official - Credentials:ACNP
Authorized Official - Phone:801-870-0329
Mailing Address - Street 1:PO BOX 362
Mailing Address - Street 2:
Mailing Address - City:PRICE
Mailing Address - State:UT
Mailing Address - Zip Code:84501-0362
Mailing Address - Country:US
Mailing Address - Phone:435-613-0733
Mailing Address - Fax:435-613-0732
Practice Address - Street 1:250 N FAIRGROUNDS RD
Practice Address - Street 2:STE 2
Practice Address - City:PRICE
Practice Address - State:UT
Practice Address - Zip Code:84501-4201
Practice Address - Country:US
Practice Address - Phone:801-870-0329
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-02
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT378942-4405363LA2100X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Multi-Specialty