Healthcare Provider Details

I. General information

NPI: 1295810109
Provider Name (Legal Business Name): SAINT CHARLES SURGICAL PAVILION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 01/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 SAINT CHARLES ST
JASPER IN
47546-9145
US

IV. Provider business mailing address

1900 SAINT CHARLES ST
JASPER IN
47546-9145
US

V. Phone/Fax

Practice location:
  • Phone: 812-634-1211
  • Fax: 812-634-9762
Mailing address:
  • Phone: 812-634-1211
  • Fax: 812-634-9762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RANDALL G NORRIS
Title or Position: OWNER/CEO
Credential: MD
Phone: 812-634-1211