Healthcare Provider Details

I. General information

NPI: 1548660012
Provider Name (Legal Business Name): VI SURGICORE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2014
Last Update Date: 09/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4050 ESTATE LA GRANDE PRINCESS 4
CHRISTIANSTED VI
00820-4328
US

IV. Provider business mailing address

4050 ESTATE LA GRANDE PRINCESS 4
CHRISTIANSTED VI
00820-4328
US

V. Phone/Fax

Practice location:
  • Phone: 414-793-3211
  • Fax:
Mailing address:
  • Phone: 414-793-3211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number1205
License Number StateVI

VIII. Authorized Official

Name: DR. REGINA FLIPPIN
Title or Position: PRESIDENT
Credential: DPM
Phone: 414-793-3211