Provider Demographics
NPI:1992766752
Name:DR. JAMES T. KATSUR AND ASSOCIATES PC
Entity type:Organization
Organization Name:DR. JAMES T. KATSUR AND ASSOCIATES PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:GARDINER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-788-6533
Mailing Address - Street 1:926 GREAT POND DR
Mailing Address - Street 2:SUITE 2003
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-7244
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1597 WASHINGTON PIKE
Practice Address - Street 2:SUITE A5
Practice Address - City:BRIDGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15017-2881
Practice Address - Country:US
Practice Address - Phone:412-279-4800
Practice Address - Fax:412-279-7119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-31
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009908580004Medicaid
PA0009908580012Medicaid
PA0009908580010Medicaid
PA0009908580022Medicaid
PA0009908580018Medicaid
PA0009908580008Medicaid
PA0009908580020Medicaid
PA0009908580015Medicaid
PA0009908580016Medicaid
PA0009908580017Medicaid
PA0009908580021Medicaid
PA0009908580002Medicaid
PA0009908580011Medicaid