Provider Demographics
NPI:1144916826
Name:LIVING MEDICINE CENTER FOR OPTIMAL HEALTH
Entity type:Organization
Organization Name:LIVING MEDICINE CENTER FOR OPTIMAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCOMBS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:206-718-4343
Mailing Address - Street 1:144 LAKESIDE ST
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-5010
Mailing Address - Country:US
Mailing Address - Phone:206-718-4343
Mailing Address - Fax:
Practice Address - Street 1:144 LAKESIDE ST
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-5010
Practice Address - Country:US
Practice Address - Phone:206-718-4343
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-14
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care