Organization
JACKIE COOMBE-MOORE PA
Active
Other names
Conway Psychiatric Center
Organization subpart
No
Provider details
NPI number
Authorized official
JACKIE COOMBE-MOORE M.D. (PRESIDENT)
(501) 505-8900
Entity
Organization
Contact information
Practice address
680 HOGAN LN, CONWAY, AR 72034-8131
(501) 505-8900
(501) 505-8902
Mailing address
680 HOGAN LN, CONWAY, AR 72034-8131
(501) 505-8900
(501) 505-8902
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11547000000
QCA
AR
05
—
122013001
—
AR
01
—
55779
MEDICARE PTAN
AR
Enumeration date
03/12/2010
Last updated
03/26/2010
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