Provider Demographics
NPI:1598751208
Name:ASSOCIATION OF SPECIALTY PHYSICIANS, INC
Entity Type:Organization
Organization Name:ASSOCIATION OF SPECIALTY PHYSICIANS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:YAKISH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-775-4242
Mailing Address - Street 1:1030 BEANER HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:PA
Mailing Address - Zip Code:15009-9723
Mailing Address - Country:US
Mailing Address - Phone:724-775-4242
Mailing Address - Fax:724-775-4960
Practice Address - Street 1:1030 BEANER HOLLOW RD
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009-9723
Practice Address - Country:US
Practice Address - Phone:724-775-4242
Practice Address - Fax:724-775-4960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-27
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015810470017Medicaid
PA851393Medicare ID - Type Unspecified
PA0015810470017Medicaid