Provider Demographics
NPI:1013290071
Name:THE YAEGER CLINIC, INC
Entity Type:Organization
Organization Name:THE YAEGER CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:YAEGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-342-3005
Mailing Address - Street 1:1177 NW 62ND ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33150-4218
Mailing Address - Country:US
Mailing Address - Phone:305-751-4208
Mailing Address - Fax:305-759-9813
Practice Address - Street 1:1177 NW 62ND ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33150-4218
Practice Address - Country:US
Practice Address - Phone:305-751-4208
Practice Address - Fax:305-759-9813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-26
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies