Provider Demographics
NPI:1467468009
Name:ST. CATHERINE PHYSICIAN SERVICES OF PENNSYLVANIA, LLC
Entity Type:Organization
Organization Name:ST. CATHERINE PHYSICIAN SERVICES OF PENNSYLVANIA, LLC
Other - Org Name:ASHLAND ORTOPEDICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:MR
Authorized Official - First Name:DUANE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BERNARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-213-1595
Mailing Address - Street 1:3891 RANCHERO DR
Mailing Address - Street 2:STE 10
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108
Mailing Address - Country:US
Mailing Address - Phone:866-822-7723
Mailing Address - Fax:734-213-1594
Practice Address - Street 1:93 BROAD ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:PA
Practice Address - Zip Code:19921-2198
Practice Address - Country:US
Practice Address - Phone:570-875-0512
Practice Address - Fax:570-875-0534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Not Answered207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Not Answered363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Not Answered367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAA51839572OtherHIGHMAKR BS
PA100310Medicare ID - Type Unspecified