Provider Demographics
NPI:1518976414
Name:BEDFORD REGIONAL UROLOGY, P.C.
Entity Type:Organization
Organization Name:BEDFORD REGIONAL UROLOGY, P.C.
Other - Org Name:STEPHEN J. YANOSHAK, D.O.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:YANOSHAK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:814-623-0552
Mailing Address - Street 1:P.O. BOX 605
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15522-2112
Mailing Address - Country:US
Mailing Address - Phone:814-623-0552
Mailing Address - Fax:814-623-0752
Practice Address - Street 1:202 MEMORIAL DR
Practice Address - Street 2:SUITE 2
Practice Address - City:EVERETT
Practice Address - State:PA
Practice Address - Zip Code:15537-7057
Practice Address - Country:US
Practice Address - Phone:814-623-0552
Practice Address - Fax:814-623-0752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS007645L208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3109330OtherALLIANCE PPO
PA58742OtherBLUE SHIELD PROVIDER NUMB
PA0015887270009Medicaid
PA17577760OtherUPMC BEST HEALTH
PA204190OtherUPMC
PA3109330OtherMAMSI
PA3109330OtherALLIANCE PPO
PA875591Medicare ID - Type UnspecifiedPROVIDER NUMBER