Healthcare Provider Details

I. General information

NPI: 1487998035
Provider Name (Legal Business Name): PROMED CLINICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2012
Last Update Date: 11/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ESTATE CANE SUITE 207,208,209
FREDERIKSTED VI
00840-4425
US

IV. Provider business mailing address

1 ESTATE CANE SUITE 205
FREDERIKSTED VI
00840-4425
US

V. Phone/Fax

Practice location:
  • Phone: 340-773-0007
  • Fax:
Mailing address:
  • Phone: 340-773-0007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number2-21364-1L
License Number StateVI

VIII. Authorized Official

Name: DR. ANTHONY RICKETTS
Title or Position: OWNER
Credential: M.D.
Phone: 340-773-0007