Provider Demographics
NPI:1083371454
Name:KATALYST HEALTHCARE CORPORATION
Entity Type:Organization
Organization Name:KATALYST HEALTHCARE CORPORATION
Other - Org Name:KATALYST HEALTHCARE GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO/CMO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON, MD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-982-6988
Mailing Address - Street 1:9893 GEORGETOWN PIKE STE 143
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:VA
Mailing Address - Zip Code:22066-2617
Mailing Address - Country:US
Mailing Address - Phone:703-263-8399
Mailing Address - Fax:
Practice Address - Street 1:11350 RANDOM HILLS RD STE 800
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-6044
Practice Address - Country:US
Practice Address - Phone:202-734-1298
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-20
Last Update Date:2021-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearch