Provider Demographics
NPI:1891016481
Name:ST CATHERINE UNIVERSITY
Entity Type:Organization
Organization Name:ST CATHERINE UNIVERSITY
Other - Org Name:ST CATHERINE UNIVERSITY HEALTH AND WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:M
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:651-690-6714
Mailing Address - Street 1:2004 RANDOLPH AVE
Mailing Address - Street 2:MAIL #4112
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105-1750
Mailing Address - Country:US
Mailing Address - Phone:651-690-6714
Mailing Address - Fax:651-690-6188
Practice Address - Street 1:2004 RANDOLPH AVE
Practice Address - Street 2:MAIL #4112
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55105-1750
Practice Address - Country:US
Practice Address - Phone:651-690-6714
Practice Address - Fax:651-690-6188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-17
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN407272080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Multi-Specialty