Provider Demographics
NPI:1497865240
Name:VINCENT T YU MD PC
Entity Type:Organization
Organization Name:VINCENT T YU MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:T
Authorized Official - Last Name:YU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-276-2116
Mailing Address - Street 1:P.O. BOX 1614
Mailing Address - Street 2:
Mailing Address - City:CANON CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81212-1614
Mailing Address - Country:US
Mailing Address - Phone:719-276-2116
Mailing Address - Fax:719-276-6919
Practice Address - Street 1:1121 MAIN ST
Practice Address - Street 2:
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212-3413
Practice Address - Country:US
Practice Address - Phone:719-276-2116
Practice Address - Fax:719-276-6919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO30832208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04017075Medicaid
CO04017075Medicaid
E83664Medicare UPIN