Tacombine LLC
Organization Active NPI Contractor · Fort Dodge, IA
NPI 1922528173 · NPPES record last updated Oct 23, 2019
Key facts
- NPI
- 1922528173
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Contractor 171W00000X
- License
- 034CC1132 (IA)
- Legal business name
- TACOMBINE LLC
- Practice address
- 215 H St
Fort Dodge, IA 50501-4501 - Phone
- (515) 571-7629
- NPI assigned
- Jun 20, 2017
- Organization subpart
- Yes
- Parent organization (as reported)
- TACOMBINE LLC
Authorized official
- Name
- Leslie J Fanning
- Title
- Owner
- Phone
- (515) 571-7629
National Provider Directory
- Part of
- Tacombine LLC
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor |
171W00000X | 034CC1132 | IA | Yes |
Addresses
Primary practice location
215 H St
Fort Dodge, IA 50501-4501
Mailing address
215 H St
Fort Dodge, IA 50501-4501
Phone (515) 571-7629
Other practice location 1
215 H St
Fort Dodge, IA 50501-4501
Phone (515) 571-7629
Other practice location 2
215 H St
Fort Dodge, IA 50501-4501
Phone (515) 571-7629
Other practice location 3
1426 5th Ave. N.
Fort dodge, IA 50501
Phone (515) 269-4974
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 812129105 | Medicaid | IA | |
| 480176313 | Medicaid | IA |
Other names
- TACOMBINELLC
Other providers in Fort Dodge, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 23, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.