Provider Demographics
NPI:1952411258
Name:CHARLES F YEAGLE, MD, PC
Entity type:Organization
Organization Name:CHARLES F YEAGLE, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:YEAGLE
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:719-846-1700
Mailing Address - Street 1:400 BENEDICTA AVE
Mailing Address - Street 2:SUITE F
Mailing Address - City:TRINIDAD
Mailing Address - State:CO
Mailing Address - Zip Code:81082-2099
Mailing Address - Country:US
Mailing Address - Phone:719-846-1700
Mailing Address - Fax:719-846-1704
Practice Address - Street 1:400 BENEDICTA AVE
Practice Address - Street 2:SUITE F
Practice Address - City:TRINIDAD
Practice Address - State:CO
Practice Address - Zip Code:81082-2099
Practice Address - Country:US
Practice Address - Phone:719-846-1700
Practice Address - Fax:719-846-1704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO41678842Medicaid
530878Medicare ID - Type Unspecified