Healthcare Provider Details

I. General information

NPI: 1144250580
Provider Name (Legal Business Name): MYRAH KEATING SMITH COMMUNITY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 10/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3B SUSSANNABERG ESTATE
ST JOHN VI
00831-0000
US

IV. Provider business mailing address

9048 SUGAR ESTATE
ST THOMAS VI
00802-3634
US

V. Phone/Fax

Practice location:
  • Phone: 340-776-8311
  • Fax: 340-714-6318
Mailing address:
  • Phone: 340-776-8311
  • Fax: 340-714-6318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateVI

VIII. Authorized Official

Name: BERNARD WHEATLEY
Title or Position: CEO
Credential:
Phone: 340-776-8311