Healthcare Provider Details

I. General information

NPI: 1952588139
Provider Name (Legal Business Name): FREDERIKSTED HEALTH CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2008
Last Update Date: 01/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 STRAND ST
FREDERIKSTED VI
00840-3533
US

IV. Provider business mailing address

PO BOX 1198
FREDERIKSTED VI
00841-1198
US

V. Phone/Fax

Practice location:
  • Phone: 340-772-1992
  • Fax: 340-772-5895
Mailing address:
  • Phone: 340-772-1992
  • Fax: 340-772-5895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number48D1002682
License Number StateVI

VIII. Authorized Official

Name: MS. ANNETTA ADAMS-HEYLIGER
Title or Position: INTERIM EXECUTIVE DIRECTOR
Credential:
Phone: 340-772-1992