1174661870 NPI number — HARRISBURG FAMILY PRACTICE LTD

Table of content: DR. MICHAEL S KATCHER MD (NPI 1417939455)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174661870 NPI number — HARRISBURG FAMILY PRACTICE LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HARRISBURG FAMILY PRACTICE LTD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SLOAN MEDICAL CLINIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174661870
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
117 E CLARK ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARRISBURG
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62946-2702
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-252-8625
Provider Business Mailing Address Fax Number:
618-252-2540

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7211 US HIGHWAY 45 S
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
CARRIER MILLS
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62917
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-994-2321
Provider Business Practice Location Address Fax Number:
618-994-2030
Provider Enumeration Date:
02/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BOATRIGHT
Authorized Official First Name:
MICHELLE
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
618-252-8625

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  036112962 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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