Provider Demographics
NPI:1134450091
Name:ST. CATHERINE HOSPITAL OCCUPATIONAL HEALTH @ST. MARY MEDICAL CENTER
Entity type:Organization
Organization Name:ST. CATHERINE HOSPITAL OCCUPATIONAL HEALTH @ST. MARY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF MANAGED CARE
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MYBECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-392-7064
Mailing Address - Street 1:1354 S LAKE PARK AVE
Mailing Address - Street 2:
Mailing Address - City:HOBART
Mailing Address - State:IN
Mailing Address - Zip Code:46342-5964
Mailing Address - Country:US
Mailing Address - Phone:219-947-6495
Mailing Address - Fax:219-947-6408
Practice Address - Street 1:1354 S LAKE PARK AVE
Practice Address - Street 2:
Practice Address - City:HOBART
Practice Address - State:IN
Practice Address - Zip Code:46342-5964
Practice Address - Country:US
Practice Address - Phone:219-947-6495
Practice Address - Fax:219-947-6408
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. CATHERINE HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-01-15
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine