Healthcare Provider Details

I. General information

NPI: 1134450091
Provider Name (Legal Business Name): ST. CATHERINE HOSPITAL OCCUPATIONAL HEALTH @ST. MARY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2010
Last Update Date: 07/11/2024
Certification Date: 07/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1354 S LAKE PARK AVE
HOBART IN
46342-5964
US

IV. Provider business mailing address

1354 S LAKE PARK AVE
HOBART IN
46342-5964
US

V. Phone/Fax

Practice location:
  • Phone: 219-947-6495
  • Fax: 219-947-6408
Mailing address:
  • Phone: 219-947-6495
  • Fax: 219-947-6408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. KEVIN MYBECK
Title or Position: DIRECTOR OF MANAGED CARE
Credential:
Phone: 219-392-7064