Healthcare Provider Details

I. General information

NPI: 1629287743
Provider Name (Legal Business Name): ST. THOMAS COMMUNITY HEALTH OUTPATIENT CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9048 SUGAR ESTATE
ST. THOMAS VI
00802
US

IV. Provider business mailing address

1303 HOSPITAL GROUND SUITE 10
ST THOMAS VI
00802-6722
US

V. Phone/Fax

Practice location:
  • Phone: 340-774-7477
  • Fax: 340-715-5121
Mailing address:
  • Phone: 340-774-7477
  • Fax: 340-715-5121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberVIGOVDOH
License Number StateVI

VIII. Authorized Official

Name: MS. ATHENIA WILLIAMS SMITH
Title or Position: PROGRAM ADMINISTRATOR
Credential:
Phone: 340-774-7477