1295919603 NPI number — JOSEPH E. YANKEE DO PC

Table of content: (NPI 1295919603)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295919603 NPI number — JOSEPH E. YANKEE DO PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOSEPH E. YANKEE DO PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295919603
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6564 SE LAKE ROAD
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
MILWAUKIE
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97222-2238
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-652-1456
Provider Business Mailing Address Fax Number:
503-652-1451

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6564 SE LAKE ROAD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
MILWAUKIE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97222-2238
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-652-1456
Provider Business Practice Location Address Fax Number:
503-652-1451
Provider Enumeration Date:
12/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
YANKEE
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
EARL
Authorized Official Title or Position:
OWNER/DOCTOR
Authorized Official Telephone Number:
503-652-1456

Provider Taxonomy Codes

  • Taxonomy code: 173000000X , with the licence number:  DO19458 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: DO19458 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 150872 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com