Basic Information
| Provider Information | |||||||||
| NPI: | 1861957193 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | VIGI LLC | ||||||||
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| OtherOrganizationName: | VIGI LLC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 11567 | ||||||||
| Address2: | |||||||||
| City: | ST THOMAS | ||||||||
| State: | VI | ||||||||
| PostalCode: | 008014567 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3407141122 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 9149 ESTATE THOMAS | ||||||||
| Address2: | PARAGON BLDG SUITE 208 | ||||||||
| City: | ST THOMAS | ||||||||
| State: | VI | ||||||||
| PostalCode: | 00802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3407141122 | ||||||||
| FaxNumber: | 3407792443 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2019 | ||||||||
| LastUpdateDate: | 10/04/2019 | ||||||||
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| AuthorizedOfficialLastName: | GUERRA | ||||||||
| AuthorizedOfficialFirstName: | ELBA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 3407141122 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Other Service Providers | Specialist | 261QA1903X | N | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical | 207RG0100X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 48D0975232 | 01 | CLIA | OTHER |