Healthcare Provider Details

I. General information

NPI: 1255706404
Provider Name (Legal Business Name): SRMC MEDICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2015
Last Update Date: 12/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9048 SUGAR EST
ST THOMAS VI
00802-3634
US

IV. Provider business mailing address

9048 SUGAR EST
ST THOMAS VI
00802-3634
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. SCOTT W NOTHNAGEL
Title or Position: CFO
Credential:
Phone: 340-776-8311