Healthcare Provider Details

I. General information

NPI: 1922916006
Provider Name (Legal Business Name): AMBROSE RADIOLOGY AND PSYCHOLOGY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 UPPER LOVENLUND GNS MAHOGANY RUN
ST. THOMAS VI
00802
US

IV. Provider business mailing address

PO BOX 600205
ST THOMAS VI
00801-6205
US

V. Phone/Fax

Practice location:
  • Phone: 615-484-6892
  • Fax:
Mailing address:
  • Phone: 615-484-6892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MAHOGANY JERVON AMBROSE
Title or Position: RADIOLOGIST
Credential: MD
Phone: 615-484-6892