Provider Demographics
NPI:1598855595
Name:ASA G. YANCEY, JR., M.D., P.C.
Entity Type:Organization
Organization Name:ASA G. YANCEY, JR., M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ASA
Authorized Official - Middle Name:GREENWOOD
Authorized Official - Last Name:YANCEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:303-740-0400
Mailing Address - Street 1:6851 SOUTH HOLLY CIRCLE
Mailing Address - Street 2:SUITE 260
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-1050
Mailing Address - Country:US
Mailing Address - Phone:303-740-0400
Mailing Address - Fax:303-770-1252
Practice Address - Street 1:6851 SOUTH HOLLY CIRCLE
Practice Address - Street 2:SUITE 260
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-1050
Practice Address - Country:US
Practice Address - Phone:303-740-0400
Practice Address - Fax:303-770-1252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO294372084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01294370Medicaid
E78873Medicare UPIN
CO01294370Medicaid