Provider Demographics
NPI:1922288141
Name:DAVID A. YATES & ASSOCIATES, LLC
Entity Type:Organization
Organization Name:DAVID A. YATES & ASSOCIATES, LLC
Other - Org Name:JP&O PROSTHETIC & ORTHOTIC LABORATORY
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROB
Authorized Official - Middle Name:A
Authorized Official - Last Name:YATES
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:870-932-6436
Mailing Address - Street 1:PO BOX 9303
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72403-9303
Mailing Address - Country:US
Mailing Address - Phone:870-932-6436
Mailing Address - Fax:
Practice Address - Street 1:1014 N SPRING ST
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-2918
Practice Address - Country:US
Practice Address - Phone:870-743-4440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-05
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1922288141Medicaid
AR168717716Medicaid
MO1922288141Medicaid