Basic Information
| Provider Information | |||||||||
| NPI: | 1205869260 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VIRGIN ISLANDS EAR NOSE AND THROAT PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 12390 | ||||||||
| Address2: | |||||||||
| City: | ST THOMAS | ||||||||
| State: | VI | ||||||||
| PostalCode: | 008015390 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3407748881 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9149 ESTATE THOMAS | ||||||||
| Address2: | STE 308 | ||||||||
| City: | ST THOMAS | ||||||||
| State: | VI | ||||||||
| PostalCode: | 008022687 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3407748881 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2006 | ||||||||
| LastUpdateDate: | 12/05/2019 | ||||||||
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| AuthorizedOfficialLastName: | SHAPIRO | ||||||||
| AuthorizedOfficialFirstName: | ADAM | ||||||||
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| AuthorizedOfficialTitleorPosition: | PROPRIETOR | ||||||||
| AuthorizedOfficialTelephone: | 3407748881 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | N | Suppliers | Durable Medical Equipment & Medical Supplies | 174400000X | 1208 | VI | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.