Healthcare Provider Details
I. General information
NPI: 1083997043
Provider Name (Legal Business Name): COMPREHENSIVE PRIMARY CARE SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 09/26/2011
Last Update Date: 09/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
9151 ESTATE THOMAS FOOTHILLS PROFESSIONAL BLDG. STE#103
ST THOMAS VI
00802-2617
US
IV. Provider business mailing address
9151 ESTATE THOMAS FOOTHILLS PROFESSIONAL BLDG. STE#103
ST THOMAS VI
00802-2617
US
V. Phone/Fax
- Phone: 340-776-0365
- Fax: 340-776-0369
- Phone: 340-776-0365
- Fax: 340-776-0369
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207R00000X |
| Taxonomy | Internal Medicine Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: DR.
LUIS
ORLANDO
AMARO
Title or Position: OWNER
Credential: M.D.
Phone: 340-776-0365