MEDICARE: GOVERNOR JUAN F. LUIS HOSPITAL & MEDICAL CENTER

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	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center

General Provider Information

NPI Number	:	1740238534
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOVERNOR JUAN F. LUIS HOSPITAL & MEDICAL CENTER

Provider Business Mailing Address
First Line	:	4007 ESTATE DIAMOND RUBY
Second Line	:	CHRISTIANSTED
City	:	ST CROIX
State	:	VI
Zip	:	00820-4435
Country	:	US
Telephone Number	:	340-778-6311
Fax Number	:	340-778-8038

Provider Business Practice Location Address
First Line	:	4007 ESTATE DIAMOND RUBY
Second Line	:	CHRISTIANSTED
City	:	ST CROIX
State	:	VI
Zip	:	00820-4435
Country	:	US
Telephone Number	:	340-778-6311
Fax Number	:	340-778-8038

Authorized Official
Title or Position	:	CHIEL FINANCIAL OFFICER
Name	:	MS. ROSALIE JAVOIS
Credential	:
Telephone Number	:	340-778-6311

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	06/13/2008

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