Provider Demographics
NPI:1700071560
Name:MARK J. YURCHISIN
Entity Type:Organization
Organization Name:MARK J. YURCHISIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:YURCHISIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-843-5111
Mailing Address - Street 1:720 2ND AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-1778
Mailing Address - Country:US
Mailing Address - Phone:270-843-5111
Mailing Address - Fax:270-843-5056
Practice Address - Street 1:720 2ND AVE STE 202
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-1778
Practice Address - Country:US
Practice Address - Phone:270-843-5111
Practice Address - Fax:270-843-5056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-13
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP00326568OtherMEDICARE RAILROAD
KY0000074762OtherBLUE CROSS
KY6003Medicare PIN
KYX57432Medicare UPIN