Healthcare Provider Details

I. General information

NPI: 1003907999
Provider Name (Legal Business Name): ST. CATHERINE PHYSICIAN SERVICES OF PENNSYLVANIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 02/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 BROAD ST
ASHLAND PA
17921-2147
US

IV. Provider business mailing address

101 BROAD ST
ASHLAND PA
17921-2147
US

V. Phone/Fax

Practice location:
  • Phone: 570-875-6835
  • Fax:
Mailing address:
  • Phone: 570-875-6835
  • Fax: 570-875-5980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT LANE
Title or Position: CHAIRMAN
Credential:
Phone: 570-875-5835