Provider Demographics
NPI:1922528199
Name:YELLOW WOLF SYSTEMS
Entity Type:Organization
Organization Name:YELLOW WOLF SYSTEMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHNNY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:EAST
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:214-505-0833
Mailing Address - Street 1:16633 DALLAS PKWY # 125
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-6816
Mailing Address - Country:US
Mailing Address - Phone:214-505-0833
Mailing Address - Fax:
Practice Address - Street 1:16633 DALLAS PKWY # 125
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-6816
Practice Address - Country:US
Practice Address - Phone:214-505-0833
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty