Provider Demographics
NPI:1649346537
Name:ST CATHERINE HOSPITAL INC
Entity type:Organization
Organization Name:ST CATHERINE HOSPITAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL DIRECTOR PATIENT FINANCIAL
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:KULLERSTRAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-934-8994
Mailing Address - Street 1:4321 FIR ST
Mailing Address - Street 2:
Mailing Address - City:EAST CHICAGO
Mailing Address - State:IN
Mailing Address - Zip Code:46312-3049
Mailing Address - Country:US
Mailing Address - Phone:219-392-7004
Mailing Address - Fax:219-934-8889
Practice Address - Street 1:4321 FIR STREET
Practice Address - Street 2:
Practice Address - City:EAST CHICAGO
Practice Address - State:IN
Practice Address - Zip Code:46312
Practice Address - Country:US
Practice Address - Phone:219-392-1700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST CATHERINE HOSPITAL INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-24
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100268330AMedicaid
IN217450Medicare ID - Type UnspecifiedGRP MEDICARE NUMBER
IN100268330AMedicaid