Basic Information
| Provider Information | |||||||||
| NPI: | 1649346537 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ST CATHERINE HOSPITAL INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4321 FIR ST | ||||||||
| Address2: | |||||||||
| City: | EAST CHICAGO | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463123049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2193927004 | ||||||||
| FaxNumber: | 2199348889 | ||||||||
| Practice Location | |||||||||
| Address1: | 4321 FIR STREET | ||||||||
| Address2: | |||||||||
| City: | EAST CHICAGO | ||||||||
| State: | IN | ||||||||
| PostalCode: | 46312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2193921700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/24/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | TRUMBO | ||||||||
| AuthorizedOfficialFirstName: | LAUREN | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 2193927116 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ST CATHERINE HOSPITAL INC | ||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | IN | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 100268330A | 05 | IN | MEDICAID |