Provider Demographics
NPI:1184825101
Name:SHIRLEY K CATRON M D PSC
Entity Type:Organization
Organization Name:SHIRLEY K CATRON M D PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:K
Authorized Official - Last Name:CATRON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-387-0675
Mailing Address - Street 1:701 BURKESVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:KY
Mailing Address - Zip Code:42602-1654
Mailing Address - Country:US
Mailing Address - Phone:606-387-0675
Mailing Address - Fax:606-387-3149
Practice Address - Street 1:701 BURKESVILLE RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:KY
Practice Address - Zip Code:42602-1654
Practice Address - Country:US
Practice Address - Phone:606-387-0675
Practice Address - Fax:606-387-3149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY38599207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64103237Medicaid
KY64103237Medicaid
KYI23410Medicare UPIN
KY0946201Medicare ID - Type Unspecified