Provider Demographics
NPI:1457718108
Name:PHILIP R. YARNELL, M.D., P.C.
Entity Type:Organization
Organization Name:PHILIP R. YARNELL, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:R
Authorized Official - Last Name:YARNELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-534-1111
Mailing Address - Street 1:3916 W CONEJOS PL
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-1444
Mailing Address - Country:US
Mailing Address - Phone:303-534-1111
Mailing Address - Fax:303-534-5052
Practice Address - Street 1:11750 W 2ND PL
Practice Address - Street 2:MEDICAL PLAZA I SUITE 255
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-1575
Practice Address - Country:US
Practice Address - Phone:303-534-1111
Practice Address - Fax:303-534-5052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-26
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04007225Medicaid
CO04007225Medicaid