1376710905 NPI number — CARIBBEAN RADIATION ONCOLOGY SERVICES, LLC

Table of content: (NPI 1376710905)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376710905 NPI number — CARIBBEAN RADIATION ONCOLOGY SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARIBBEAN RADIATION ONCOLOGY SERVICES, LLC
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:
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NPI Number Information

NPI Number:
1376710905
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/13/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9160 ESTATE THOMAS
Provider Second Line Business Mailing Address:
PMB 217
Provider Business Mailing Address City Name:
ST THOMAS
Provider Business Mailing Address State Name:
VI
Provider Business Mailing Address Postal Code:
00802-2687
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
340-775-5433
Provider Business Mailing Address Fax Number:
340-714-5433

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9048 SUGAR ESTATE
Provider Second Line Business Practice Location Address:
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:
340-775-5433
Provider Business Practice Location Address Fax Number:
340-714-5433
Provider Enumeration Date:
05/13/2008

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIAMSON
Authorized Official First Name:
SHIRNETT
Authorized Official Middle Name:
KAREAN
Authorized Official Title or Position:
DIRECTOR OF RADIATION ONCOLOGY
Authorized Official Telephone Number:
340-775-5433

Provider Taxonomy Codes

  • Taxonomy code: 2085R0001X , with the licence number:  1320 , 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)





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