Healthcare Provider Details

I. General information

NPI: 1245362508
Provider Name (Legal Business Name): THE GUY ALEXANDER AMBULATORY MEDICINE ACADEMY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SUNNY ISLE PROFESSIONAL BLDG SUITE 3F
CHRISTIANSTED VI
00823-7840
US

IV. Provider business mailing address

4093 DIAMOND RUBY SUITE #7 PMB #147
CHRISTIANSTED VI
00820-4424
US

V. Phone/Fax

Practice location:
  • Phone: 340-643-8484
  • Fax: 302-261-0216
Mailing address:
  • Phone: 340-643-8484
  • Fax: 302-261-0216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number1366
License Number StateVI

VIII. Authorized Official

Name: DR. W JOSEPH GORUM II
Title or Position: PRES
Credential: MD
Phone: 340-643-8484