Provider Demographics
NPI:1841230695
Name:BASIL M YATES MD PA
Entity Type:Organization
Organization Name:BASIL M YATES MD PA
Other - Org Name:BASIL M YATES MD PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NURSE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:YATES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-836-1940
Mailing Address - Street 1:590 E 25TH ST
Mailing Address - Street 2:STE 601
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-3841
Mailing Address - Country:US
Mailing Address - Phone:305-836-1940
Mailing Address - Fax:305-693-0098
Practice Address - Street 1:590 E 25TH ST
Practice Address - Street 2:STE 601
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-3841
Practice Address - Country:US
Practice Address - Phone:305-836-1940
Practice Address - Fax:305-693-0098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0007781332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
1015862OtherNCPDP PROVIDER IDENTIFICATION NUMBER
FL00655Medicare PIN