Provider Demographics
NPI:1265767909
Name:MARTHA F YEARSLEY M.D. PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:MARTHA F YEARSLEY M.D. PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:YEARSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-482-5700
Mailing Address - Street 1:1005 DORBETT ST
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-2619
Mailing Address - Country:US
Mailing Address - Phone:812-482-5700
Mailing Address - Fax:812-481-1045
Practice Address - Street 1:1005 DORBETT ST
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-2619
Practice Address - Country:US
Practice Address - Phone:812-482-5700
Practice Address - Fax:812-481-1045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01042841A208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100414290BMedicaid
IN990007893OtherMEDICARE RAILROAD
BY3229122OtherDEA
INF46493Medicare UPIN