MEDICARE: DR. MARTHA ANNE YEARY MD

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QA0401X	Addiction Medicine (Family Medicine) Physician	33351	KY
2	207Q00000X	Family Medicine Physician	33351	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	K008391	OTHER	KY	GROUP PTAN
3	33351	OTHER	KY	LICENSE

General Provider Information

NPI Number	:	1194776831
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARTHA ANNE YEARY MD

Provider Business Mailing Address
First Line	:	PO BOX 1780
Second Line	:
City	:	COLUMBIA
State	:	KY
Zip	:	42728-6780
Country	:	US
Telephone Number	:	270-384-0233
Fax Number	:	270-384-0245

Provider Business Practice Location Address
First Line	:	805 BURKESVILLE ST
Second Line	:
City	:	COLUMBIA
State	:	KY
Zip	:	42728-1655
Country	:	US
Telephone Number	:	270-384-0233
Fax Number	:	270-384-0245

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	07/29/2024

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