| St Croix Family Medicine, Llc | |
|
4500 Sunny Isle Christiansted VI 00820-5173 | |
| (340) 692-2600 | |
| (340) 692-2602 |
| Full Name | St Croix Family Medicine, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 4500 Sunny Isle, Christiansted, Virgin Island |
| Authorized Official Name and Position | Gemaine Diane Owen (MANAGER/MEMBER) |
| Authorized Official Contact | 3406922600 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| St Croix Family Medicine, Llc Rr 2 Box 10565 Suite 107, The Village Mall Kingshill VI 00850-9604 Ph: (340) 692-2600 | St Croix Family Medicine, Llc 4500 Sunny Isle Christiansted VI 00820-5173 Ph: (340) 692-2600 |
| NPI Number | 1841560059 |
|---|---|
| Provider Enumeration Date | 01/04/2012 |
| Last Update Date | 05/16/2019 |
| Medicare PECOS PAC ID | 5890941603 |
|---|---|
| Medicare Enrollment ID | O20120810000277 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841560059 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 2-14663-1L (Virgin Island) | Primary |
| Provider Name | Gemaine D Owen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1891819017 PECOS PAC ID: 5092782060 Enrollment ID: I20080414000458 |
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