Healthcare Provider Details

I. General information

NPI: 1861432593
Provider Name (Legal Business Name): LOUIS A YANCICH D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 02/02/2023
Certification Date: 02/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1535 SLATE CREEK RD
GRUNDY VA
24614-6974
US

IV. Provider business mailing address

PO BOX 470
POINT PLEASANT WV
25550-0470
US

V. Phone/Fax

Practice location:
  • Phone: 276-935-1000
  • Fax:
Mailing address:
  • Phone: 304-273-0113
  • Fax: 304-273-0115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146D00000X
TaxonomyPersonal Emergency Response Attendant
License Number02003033A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number1453
License Number StateWV
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34.007997
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number1453
License Number StateWV
# 5
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0102204367
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: