Healthcare Provider Details

I. General information

NPI: 1255453023
Provider Name (Legal Business Name): VI ANESTHESIA GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 05/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9048 SUGAR ESTATE
ST THOMAS VI
00802
US

IV. Provider business mailing address

225 S EXECUTIVE DR
BROOKFIELD WI
53005-4257
US

V. Phone/Fax

Practice location:
  • Phone: 340-776-8311
  • Fax:
Mailing address:
  • Phone: 262-787-4026
  • Fax: 262-782-6040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number1321
License Number StateVI
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number1296
License Number StateVI
# 3
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number1082
License Number StateVI

VIII. Authorized Official

Name: KATHY H DEKALB
Title or Position: SUPERVISOR
Credential:
Phone: 262-787-4026