1356675458 NPI number — DEPT OF HEALTH, GOVT OF VI/MORRIS DECASTRO CLINIC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356675458 NPI number — DEPT OF HEALTH, GOVT OF VI/MORRIS DECASTRO CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DEPT OF HEALTH, GOVT OF VI/MORRIS DECASTRO CLINIC
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:
1356675458
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/23/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1303 HOSPITAL GROUND, STE#10
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
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
340-776-8311
Provider Business Mailing Address Fax Number:
340-777-4001

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4D STRAND STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CRUZ BAY, ST JOHN
Provider Business Practice Location Address State Name:
VI
Provider Business Practice Location Address Postal Code:
00803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
340-777-7477
Provider Business Practice Location Address Fax Number:
340-777-4001
Provider Enumeration Date:
09/23/2009

Additional Information

Authorized Official

Authorized Official Last Name:
SHEEN
Authorized Official First Name:
JULIA
Authorized Official Middle Name:
Authorized Official Title or Position:
COMMISSIONER OF HEALTH
Authorized Official Telephone Number:
340-773-1311

Provider Taxonomy Codes

  • Taxonomy code: 251K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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