Healthcare Provider Details

I. General information

NPI: 1780440495
Provider Name (Legal Business Name): CATALYST MEDICAL GROUP, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2024
Last Update Date: 02/21/2024
Certification Date: 02/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 WARNER DR
LEWISTON ID
83501-4441
US

IV. Provider business mailing address

2315 8TH ST
LEWISTON ID
83501-7301
US

V. Phone/Fax

Practice location:
  • Phone: 208-746-1383
  • Fax: 208-298-4525
Mailing address:
  • Phone: 208-748-1383
  • Fax: 208-298-4525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KARL E SUNDBERG
Title or Position: CEO
Credential:
Phone: 208-298-3100