Healthcare Provider Details

I. General information

NPI: 1235486200
Provider Name (Legal Business Name): SURF MEDICAL SOURCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2012
Last Update Date: 08/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9149 ESTATE THOMAS PARAGON MEDICAL BUILDING STE 304
ST THOMAS VI
00802-2615
US

IV. Provider business mailing address

PO BOX 12423
ST THOMAS VI
00801-5423
US

V. Phone/Fax

Practice location:
  • Phone: 340-714-5151
  • Fax: 708-335-2294
Mailing address:
  • Phone: 340-714-5151
  • Fax: 708-335-2294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY W FOX
Title or Position: MANAGER
Credential:
Phone: 340-714-5151