Provider Demographics
NPI:1154734622
Name:COLLEGEVILLE MEDICAL CENTER PC
Entity type:Organization
Organization Name:COLLEGEVILLE MEDICAL CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEM
Authorized Official - Middle Name:
Authorized Official - Last Name:YENAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-489-8645
Mailing Address - Street 1:PO BOX 299
Mailing Address - Street 2:
Mailing Address - City:DELAWARE WATER GAP
Mailing Address - State:PA
Mailing Address - Zip Code:18327-0299
Mailing Address - Country:US
Mailing Address - Phone:610-489-8645
Mailing Address - Fax:610-489-6329
Practice Address - Street 1:753 W MAIN ST
Practice Address - Street 2:
Practice Address - City:TRAPPE
Practice Address - State:PA
Practice Address - Zip Code:19426-1948
Practice Address - Country:US
Practice Address - Phone:601-489-8645
Practice Address - Fax:610-489-6329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-03
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty