Provider Demographics
NPI:1699860957
Name:ERNESTO A MCCOMBS CHARTERED
Entity type:Organization
Organization Name:ERNESTO A MCCOMBS CHARTERED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERNESTO
Authorized Official - Middle Name:ARCADIO
Authorized Official - Last Name:MCCOMBS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:702-822-4441
Mailing Address - Street 1:PO BOX 27110
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89126-1110
Mailing Address - Country:US
Mailing Address - Phone:702-822-4441
Mailing Address - Fax:702-822-1263
Practice Address - Street 1:501 S RANCHO DR
Practice Address - Street 2:SUITE C-15
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4828
Practice Address - Country:US
Practice Address - Phone:702-822-4441
Practice Address - Fax:702-822-1263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV660207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVF58829Medicare UPIN