Provider Demographics
NPI:1225210552
Name:CATHERINE LOUISE YACK
Entity Type:Organization
Organization Name:CATHERINE LOUISE YACK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:YACK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:256-533-3668
Mailing Address - Street 1:2006 FRANKLIN ST SE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-4551
Mailing Address - Country:US
Mailing Address - Phone:256-533-3668
Mailing Address - Fax:256-533-2577
Practice Address - Street 1:2006 FRANKLIN ST SE
Practice Address - Street 2:SUITE 106
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4551
Practice Address - Country:US
Practice Address - Phone:256-533-3668
Practice Address - Fax:256-533-2577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-28
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00129261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALT89090Medicare UPIN
AL0535470001Medicare NSC