Healthcare Provider Details

I. General information

NPI: 1164545950
Provider Name (Legal Business Name): PODIATRIC MEDICAL SERVICES FOR AMBULATORY SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 08/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 SION FARM SUITE 7
ST. CROIX VI
00820
US

IV. Provider business mailing address

4100 SION FARM
ST. CROIX VI
00820
US

V. Phone/Fax

Practice location:
  • Phone: 340-713-8397
  • Fax: 340-719-5301
Mailing address:
  • Phone: 340-713-8397
  • Fax: 340-719-5103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. IAN KEITH COOK
Title or Position: MEMBER
Credential: D.P.M.
Phone: 340-713-8397