Provider Demographics
NPI:1639352610
Name:ST CATHERINE PHYSICIAN SERVICES, LLC
Entity Type:Organization
Organization Name:ST CATHERINE PHYSICIAN SERVICES, LLC
Other - Org Name:SAINT CATHERINE MEDICAL GROUP, MSO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ROSIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:TAULBEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-256-7436
Mailing Address - Street 1:2100 MARKET ST.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHARLESTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47111-9535
Mailing Address - Country:US
Mailing Address - Phone:812-256-9714
Mailing Address - Fax:812-256-9702
Practice Address - Street 1:2100 MARKET ST.
Practice Address - Street 2:SUITE 100
Practice Address - City:CHARLESTOWN
Practice Address - State:IN
Practice Address - Zip Code:47111-9535
Practice Address - Country:US
Practice Address - Phone:812-256-9714
Practice Address - Fax:812-256-9702
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAINT CATHERINE PHYSICIANS SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-12
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01027298A207P00000X
IN01028535A207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000549974OtherANTHEM BC/BS
INB28860OtherUPIN
INB28860OtherUPIN