MEDICARE: ORTHOCARIBBEAN PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	1499	VI
2	335E00000X	Prosthetic/Orthotic Supplier	1499	VI
3	335E00000X	Prosthetic/Orthotic Supplier	653	VI

General Provider Information

NPI Number	:	1770866741
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORTHOCARIBBEAN PC

Provider Business Mailing Address
First Line	:	PO BOX 7840
Second Line	:
City	:	CHRISTIANSTED
State	:	VI
Zip	:	00823-7840
Country	:	US
Telephone Number	:	340-778-6110
Fax Number	:	340-778-2919

Provider Business Practice Location Address
First Line	:	SUNNY ISLE PROFESSIONAL BLDG
Second Line	:	SUITE 3F
City	:	CHRISTIANSTED
State	:	VI
Zip	:	00820-4423
Country	:	US
Telephone Number	:	340-778-6110
Fax Number	:	340-778-2919

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	BRENDA PEDERSEN
Credential	:
Telephone Number	:	340-778-6110

Provider Enumeration Date	:	09/26/2011
Last Update Date	:	09/26/2011

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