Provider Demographics
NPI:1821268152
Name:MELANIA YEATS PC
Entity Type:Organization
Organization Name:MELANIA YEATS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MELANIA
Authorized Official - Middle Name:
Authorized Official - Last Name:YEATS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-327-9694
Mailing Address - Street 1:622 W MAPLE ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-6590
Mailing Address - Country:US
Mailing Address - Phone:505-327-9694
Mailing Address - Fax:505-327-7524
Practice Address - Street 1:622 W MAPLE ST
Practice Address - Street 2:SUITE C
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-6590
Practice Address - Country:US
Practice Address - Phone:505-327-9694
Practice Address - Fax:505-327-7524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2003-0177208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty