Healthcare Provider Details

I. General information

NPI: 1215208632
Provider Name (Legal Business Name): AMBULATORY CARE CLINIC L.L.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2012
Last Update Date: 06/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1619 SIXTH ST
ST THOMAS VI
00802-2635
US

IV. Provider business mailing address

1619 SIXTH ST
ST THOMAS VI
00802-2635
US

V. Phone/Fax

Practice location:
  • Phone: 340-643-7233
  • Fax:
Mailing address:
  • Phone: 340-643-7233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number1-16363-1L
License Number StateVI

VIII. Authorized Official

Name: DR. ELIZABETH FLOWER
Title or Position: MEMBER-MANAGER
Credential: M.D
Phone: 340-642-7233