Provider Demographics
NPI:1710203013
Name:DAVID A. YATES & ASSOCIATES, LLC
Entity type:Organization
Organization Name:DAVID A. YATES & ASSOCIATES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROB
Authorized Official - Middle Name:A
Authorized Official - Last Name:YATES
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:870-932-6436
Mailing Address - Street 1:PO BOX 9303
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72403-9303
Mailing Address - Country:US
Mailing Address - Phone:870-932-6436
Mailing Address - Fax:
Practice Address - Street 1:526 BRANSON LANDING BLVD
Practice Address - Street 2:STE 1
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-2092
Practice Address - Country:US
Practice Address - Phone:417-213-3128
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-12
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1710203013OtherMEDICAID
0246660005Medicare NSC