Provider Demographics
NPI:1023195021
Name:CENTER FOR OTOLARYNGOLOGY AND FACIAL PLASTIC SURGERY, L.L.C.
Entity Type:Organization
Organization Name:CENTER FOR OTOLARYNGOLOGY AND FACIAL PLASTIC SURGERY, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BETHANY
Authorized Official - Middle Name:A
Authorized Official - Last Name:CATALDI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:219-836-4820
Mailing Address - Street 1:PO BOX 958
Mailing Address - Street 2:
Mailing Address - City:SCHERERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46375-0958
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2203 45TH ST
Practice Address - Street 2:SUITE 'B'
Practice Address - City:HIGHLAND
Practice Address - State:IN
Practice Address - Zip Code:46322-2601
Practice Address - Country:US
Practice Address - Phone:219-836-4820
Practice Address - Fax:219-836-5186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02002695A207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200841030 AMedicaid
IN200841030 AMedicaid