Provider Demographics
NPI:1548660012
Name:VI SURGICORE LLC
Entity type:Organization
Organization Name:VI SURGICORE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:FLIPPIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:414-793-3211
Mailing Address - Street 1:4050 ESTATE LA GRANDE PRINCESS
Mailing Address - Street 2:4
Mailing Address - City:CHRISTIANSTED
Mailing Address - State:VI
Mailing Address - Zip Code:00820-4328
Mailing Address - Country:US
Mailing Address - Phone:414-793-3211
Mailing Address - Fax:
Practice Address - Street 1:4050 ESTATE LA GRANDE PRINCESS
Practice Address - Street 2:4
Practice Address - City:CHRISTIANSTED
Practice Address - State:VI
Practice Address - Zip Code:00820-4328
Practice Address - Country:US
Practice Address - Phone:414-793-3211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-03
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI1205261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical