1033639448 NPI number — PODIATRIC MEDICAL SERVICES FOR AMBULATOY SURGERY, INC

Table of content: (NPI 1033639448)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033639448 NPI number — PODIATRIC MEDICAL SERVICES FOR AMBULATOY SURGERY, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PODIATRIC MEDICAL SERVICES FOR AMBULATOY SURGERY, INC
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:
Provider Other Organization Name Type Code:
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:
1033639448
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/27/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 10012
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST THOMAS
Provider Business Mailing Address State Name:
VI
Provider Business Mailing Address Postal Code:
00801-3012
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
340-626-3714
Provider Business Mailing Address Fax Number:
877-349-0205

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
#19 SIXTH STREET
Provider Second Line Business Practice Location Address:
SUGAR ESTATE
Provider Business Practice Location Address City Name:
ST. THOMAS
Provider Business Practice Location Address State Name:
VI
Provider Business Practice Location Address Postal Code:
00802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
340-626-3714
Provider Business Practice Location Address Fax Number:
877-349-0205
Provider Enumeration Date:
06/27/2017

Additional Information

Authorized Official

Authorized Official Last Name:
WEBSTER
Authorized Official First Name:
NAVETTA
Authorized Official Middle Name:
EUDORA
Authorized Official Title or Position:
SPECIAL PROJECTS DIRECTOR
Authorized Official Telephone Number:
340-626-3714

Provider Taxonomy Codes

  • Taxonomy code: 207PE0005X , with the licence number:  1058 , registered in the state of VI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QA1903X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: C000000083123 . This is a "DRIVERS LICENSE" identifier , issued by the state of ( VI ) . This identifiers is of the category "OTHER".




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