MEDICARE: COLLEGEVILLE MEDICAL CENTER PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207Q00000X	Family Medicine Physician
2	208D00000X	General Practice Physician
3	363A00000X	Physician Assistant
4	363L00000X	Nurse Practitioner
5	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1154734622
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLLEGEVILLE MEDICAL CENTER PC

Provider Business Mailing Address
First Line	:	PO BOX 299
Second Line	:
City	:	DELAWARE WATER GAP
State	:	PA
Zip	:	18327-0299
Country	:	US
Telephone Number	:	610-489-8645
Fax Number	:	610-489-6329

Provider Business Practice Location Address
First Line	:	753 W MAIN ST
Second Line	:
City	:	TRAPPE
State	:	PA
Zip	:	19426-1948
Country	:	US
Telephone Number	:	601-489-8645
Fax Number	:	610-489-6329

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KEM YENAL
Credential	:	MD
Telephone Number	:	610-489-8645

Provider Enumeration Date	:	06/03/2014
Last Update Date	:	10/01/2014

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Directions to “COLLEGEVILLE MEDICAL CENTER PC ” Practice Location

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