Organization
TACOMBINE LLC
Active
Parent organization
TACOMBINE LLC
Other names
TACOMBINELLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
TACOMBINE LLC
Authorized official
LESLIE J FANNING (OWNER)
(515) 571-7629
Entity
Organization
Contact information
Practice address
215 H ST, FORT DODGE, IA 50501-4501
(515) 571-7629
Mailing address
215 H ST, FORT DODGE, IA 50501-4501
(515) 571-7629
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
034CC1132
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
480176313
—
IA
05
—
812129105
—
IA
Enumeration date
06/20/2017
Last updated
10/23/2019
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