Provider Demographics
NPI:1255958658
Name:YADEN PHYSICAL AND INTEGRATED MEDICAL-LLC
Entity type:Organization
Organization Name:YADEN PHYSICAL AND INTEGRATED MEDICAL-LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JERALD
Authorized Official - Middle Name:G
Authorized Official - Last Name:YADEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:843-899-7933
Mailing Address - Street 1:425 BARONY ST
Mailing Address - Street 2:
Mailing Address - City:MONCKS CORNER
Mailing Address - State:SC
Mailing Address - Zip Code:29461-3128
Mailing Address - Country:US
Mailing Address - Phone:843-899-7933
Mailing Address - Fax:843-899-5796
Practice Address - Street 1:425 BARONY ST
Practice Address - Street 2:
Practice Address - City:MONCKS CORNER
Practice Address - State:SC
Practice Address - Zip Code:29461-3128
Practice Address - Country:US
Practice Address - Phone:843-899-7933
Practice Address - Fax:843-899-5796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-01
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty