Healthcare Provider Details

I. General information

NPI: 1376628867
Provider Name (Legal Business Name): DOCTORS CLINICAL LABORATORY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10TH STREET ESTATE THOMAS
ST THOMAS VI
00804
US

IV. Provider business mailing address

PO BOX 10500
ST THOMAS VI
00801-3500
US

V. Phone/Fax

Practice location:
  • Phone: 340-774-2760
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateVI

VIII. Authorized Official

Name: MRS. CYNTHIA DEGUIA BURT
Title or Position: LABORATORY DIRECTOR
Credential:
Phone: 340-774-2760