Healthcare Provider Details

I. General information

NPI: 1205878733
Provider Name (Legal Business Name): GEORGE A YEATS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 02/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2640 HWY 2 EAST
KALISPELL MT
59901-3227
US

IV. Provider business mailing address

2640 HWY 2 EAST
KALISPELL MT
59901-3227
US

V. Phone/Fax

Practice location:
  • Phone: 406-257-2083
  • Fax: 406-755-3219
Mailing address:
  • Phone: 406-257-2083
  • Fax: 406-755-3219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number1228
License Number StateMT

VIII. Authorized Official

Name: JODY YEATS
Title or Position: CO-OWNER
Credential:
Phone: 406-257-2083