Healthcare Provider Details

I. General information

NPI: 1316172646
Provider Name (Legal Business Name): ST CATHERINE HOSPTIAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2009
Last Update Date: 07/11/2024
Certification Date: 07/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4320 FIR ST STE 201
EAST CHICAGO IN
46312-3052
US

IV. Provider business mailing address

4320 FIR ST STE 201
EAST CHICAGO IN
46312-3052
US

V. Phone/Fax

Practice location:
  • Phone: 219-392-7664
  • Fax: 219-392-7980
Mailing address:
  • Phone: 219-392-7664
  • Fax: 219-392-7980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number01065445A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: LEOBARDO CORREA
Title or Position: CEO
Credential:
Phone: 219-392-1700