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General NPI Number Information
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NPI Number | 1841560059
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Entity Type | Organization
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Legal Business Name | ST CROIX FAMILY MEDICINE, LLC
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Dates
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Enumeration Date | 01/04/2012
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Last Update Date | 05/16/2019
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Provider Practice Location Address
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Address Line | 4500 SUNNY ISLE
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City | CHRISTIANSTED
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State | VI
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Zip | 00820-5173
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Country | US
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Telephone | 340-692-2600
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Fax | 340-692-2602
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Provider Business Mailing Address
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Address Line | RR 2 BOX 10565 SUITE 107, THE VILLAGE MALL
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City | KINGSHILL
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State | VI
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Zip | 00850-9604
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Country | US
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Telephone | 340-692-2600
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Fax | 340-692-2602
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Authorized Official
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Title or Position | MANAGER/MEMBER
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Name | DR. GEMAINE DIANE OWEN
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Credential | M.D.
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Telephone | 340-692-2600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 2-14663-1L
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License Number State | VI
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