MEDICARE: VI SURGICORE LLC

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	261QA1903X	Ambulatory Surgical Clinic/Center	1205	VI

General Provider Information

NPI Number	:	1548660012
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VI SURGICORE LLC

Provider Business Mailing Address
First Line	:	4050 ESTATE LA GRANDE PRINCESS
Second Line	:	4
City	:	CHRISTIANSTED
State	:	VI
Zip	:	00820-4328
Country	:	US
Telephone Number	:	414-793-3211
Fax Number	:

Provider Business Practice Location Address
First Line	:	4050 ESTATE LA GRANDE PRINCESS
Second Line	:	4
City	:	CHRISTIANSTED
State	:	VI
Zip	:	00820-4328
Country	:	US
Telephone Number	:	414-793-3211
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. REGINA FLIPPIN
Credential	:	DPM
Telephone Number	:	414-793-3211

Provider Enumeration Date	:	09/03/2014
Last Update Date	:	09/03/2014

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