Healthcare Provider Details

I. General information

NPI: 1952929689
Provider Name (Legal Business Name): YASIR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2020
Last Update Date: 09/22/2020
Certification Date: 09/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 FINANCIAL PL STE 300
ELIZABETHTOWN KY
42701-4470
US

IV. Provider business mailing address

103 FINANCIAL PL STE 300
ELIZABETHTOWN KY
42701-4470
US

V. Phone/Fax

Practice location:
  • Phone: 270-600-0136
  • Fax:
Mailing address:
  • Phone: 270-600-0136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: YASIR SAIFULLAH
Title or Position: OWNER
Credential: MD
Phone: 270-600-0136