1144250580 NPI number — MYRAH KEATING SMITH COMMUNITY HEALTH CENTER

Table of content: (NPI 1144250580)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144250580 NPI number — MYRAH KEATING SMITH COMMUNITY HEALTH CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MYRAH KEATING SMITH COMMUNITY HEALTH CENTER
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:
6
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:
1144250580
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/12/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9048 SUGAR ESTATE
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:
00802-3634
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
340-776-8311
Provider Business Mailing Address Fax Number:
340-714-6318

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3B SUSSANNABERG ESTATE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST JOHN
Provider Business Practice Location Address State Name:
VI
Provider Business Practice Location Address Postal Code:
00831-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
340-776-8311
Provider Business Practice Location Address Fax Number:
340-714-6318
Provider Enumeration Date:
07/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WHEATLEY
Authorized Official First Name:
BERNARD
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
340-776-8311

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , registered in the state of VI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com