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General NPI Number Information
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NPI Number | 1154734622
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Entity Type | Organization
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Legal Business Name | COLLEGEVILLE MEDICAL CENTER PC
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Dates
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Enumeration Date | 06/03/2014
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Last Update Date | 10/01/2014
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Provider Practice Location Address
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Address Line | 753 W MAIN ST
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City | TRAPPE
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State | PA
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Zip | 19426-1948
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Country | US
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Telephone | 601-489-8645
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Fax | 610-489-6329
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Provider Business Mailing Address
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Address Line | PO BOX 299
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City | DELAWARE WATER GAP
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State | PA
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Zip | 18327-0299
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Country | US
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Telephone | 610-489-8645
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Fax | 610-489-6329
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Authorized Official
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Title or Position | OWNER
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Name | DR. KEM YENAL
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Credential | MD
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Telephone | 610-489-8645
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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