Provider Demographics
NPI:1033639448
Name:PODIATRIC MEDICAL SERVICES FOR AMBULATOY SURGERY, INC
Entity type:Organization
Organization Name:PODIATRIC MEDICAL SERVICES FOR AMBULATOY SURGERY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPECIAL PROJECTS DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:NAVETTA
Authorized Official - Middle Name:EUDORA
Authorized Official - Last Name:WEBSTER
Authorized Official - Suffix:
Authorized Official - Credentials:BPH
Authorized Official - Phone:340-626-3714
Mailing Address - Street 1:PO BOX 10012
Mailing Address - Street 2:
Mailing Address - City:ST THOMAS
Mailing Address - State:VI
Mailing Address - Zip Code:00801-3012
Mailing Address - Country:US
Mailing Address - Phone:340-626-3714
Mailing Address - Fax:877-349-0205
Practice Address - Street 1:#19 SIXTH STREET
Practice Address - Street 2:SUGAR ESTATE
Practice Address - City:ST. THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802
Practice Address - Country:US
Practice Address - Phone:340-626-3714
Practice Address - Fax:877-349-0205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-27
Last Update Date:2017-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI1058207PE0005X
261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VIC000000083123OtherDRIVERS LICENSE