Provider Demographics
NPI:1316184120
Name:10K SPORTS MEDICINE, PC
Entity Type:Organization
Organization Name:10K SPORTS MEDICINE, PC
Other - Org Name:10KSPORTSMED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:YEAKEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-293-4897
Mailing Address - Street 1:PO BOX 943
Mailing Address - Street 2:
Mailing Address - City:LEADVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80461-0943
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:UNIT 101B
Practice Address - Street 2:12 SNOWMASS RD
Practice Address - City:CRESTED BUTTE
Practice Address - State:CO
Practice Address - Zip Code:81224-8046
Practice Address - Country:US
Practice Address - Phone:719-293-4897
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-15
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Single Specialty