Provider Demographics
NPI:1497309827
Name:YAHWEH MEDICAL CLINIC PSC
Entity Type:Organization
Organization Name:YAHWEH MEDICAL CLINIC PSC
Other - Org Name:YAHWEH MEDICAL CLINIC PSC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHER
Authorized Official - Middle Name:
Authorized Official - Last Name:GABRIEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-790-2862
Mailing Address - Street 1:3589 HIGHWAY 33 S
Mailing Address - Street 2:
Mailing Address - City:NEW TAZEWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37825-2319
Mailing Address - Country:US
Mailing Address - Phone:631-790-2862
Mailing Address - Fax:
Practice Address - Street 1:3513 CUMBERLAND AVE
Practice Address - Street 2:
Practice Address - City:MIDDLESBORO
Practice Address - State:KY
Practice Address - Zip Code:40965-2611
Practice Address - Country:US
Practice Address - Phone:631-790-2862
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-24
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty