Healthcare Provider Details

I. General information

NPI: 1740238534
Provider Name (Legal Business Name): GOVERNOR JUAN F. LUIS HOSPITAL & MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 06/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4007 ESTATE DIAMOND RUBY CHRISTIANSTED
ST CROIX VI
00820-4435
US

IV. Provider business mailing address

4007 ESTATE DIAMOND RUBY CHRISTIANSTED
ST CROIX VI
00820-4435
US

V. Phone/Fax

Practice location:
  • Phone: 340-778-6311
  • Fax: 340-778-8038
Mailing address:
  • Phone: 340-778-6311
  • Fax: 340-778-8038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. ROSALIE JAVOIS
Title or Position: CHIEL FINANCIAL OFFICER
Credential:
Phone: 340-778-6311