Healthcare Provider Details

I. General information

NPI: 1689453722
Provider Name (Legal Business Name): SAINT CROIX PODIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2023
Last Update Date: 01/09/2024
Certification Date: 11/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 BEESTON HILL MEDICAL CTR STE 9
CHRISTIANSTED VI
00820-5254
US

IV. Provider business mailing address

4000 BEESTON HILL MEDICAL CTR STE 9
CHRISTIANSTED VI
00820-5254
US

V. Phone/Fax

Practice location:
  • Phone: 540-498-7301
  • Fax:
Mailing address:
  • Phone: 340-718-0030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: JOHN W COOK
Title or Position: OWNER
Credential: DPM
Phone: 340-718-0030