Provider Demographics
NPI:1053863043
Name:MYRAH KEATING SMITH COMMUNITY HEALTH CENTER
Entity Type:Organization
Organization Name:MYRAH KEATING SMITH COMMUNITY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:
Authorized Official - Last Name:WHEATLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:340-776-8311
Mailing Address - Street 1:9048 SUGAR EST
Mailing Address - Street 2:
Mailing Address - City:ST THOMAS
Mailing Address - State:VI
Mailing Address - Zip Code:00802-3634
Mailing Address - Country:US
Mailing Address - Phone:340-776-8311
Mailing Address - Fax:340-714-6318
Practice Address - Street 1:9048 SUGAR EST
Practice Address - Street 2:
Practice Address - City:ST THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802-3634
Practice Address - Country:US
Practice Address - Phone:340-776-8311
Practice Address - Fax:340-714-6318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-26
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
VI0080256Medicare PIN