Healthcare Provider Details

I. General information

NPI: 1407219173
Provider Name (Legal Business Name): ASSOCIATION OF SPECIALTY PHYSICIANS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2016
Last Update Date: 08/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

274 3RD ST
BEAVER PA
15009-2333
US

IV. Provider business mailing address

274 3RD ST
BEAVER PA
15009-2333
US

V. Phone/Fax

Practice location:
  • Phone: 724-775-2112
  • Fax: 724-775-2131
Mailing address:
  • Phone: 724-775-2112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SAMUEL DALE YAKIS
Title or Position: PRESIDENT
Credential: MD
Phone: 724-775-4242