MEDICARE: FREDERIKSTED HEALTH CARE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1164842050
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FREDERIKSTED HEALTH CARE, INC.

Provider Business Mailing Address
First Line	:	PO BOX 1198
Second Line	:
City	:	FREDERIKSTED
State	:	VI
Zip	:	00841-1198
Country	:	US
Telephone Number	:	340-772-0260
Fax Number	:	340-772-5895

Provider Business Practice Location Address
First Line	:	6C ESTATE LA GRANDE PRINCESSE
Second Line	:
City	:	CHRISTIANSTED
State	:	VI
Zip	:	00820-4328
Country	:	US
Telephone Number	:	340-772-0260
Fax Number	:	340-718-1090

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. MASSERAE E. SPRAUVE-WEBSTER
Credential	:
Telephone Number	:	340-772-1992

Provider Enumeration Date	:	04/18/2014
Last Update Date	:	04/18/2014

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