Provider Demographics
NPI:1164545950
Name:PODIATRIC MEDICAL SERVICES FOR AMBULATORY SERVICES PLLC
Entity Type:Organization
Organization Name:PODIATRIC MEDICAL SERVICES FOR AMBULATORY SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:IAN
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:340-713-8397
Mailing Address - Street 1:4100 SION FARM
Mailing Address - Street 2:
Mailing Address - City:ST. CROIX
Mailing Address - State:VI
Mailing Address - Zip Code:00820
Mailing Address - Country:US
Mailing Address - Phone:340-713-8397
Mailing Address - Fax:340-719-5103
Practice Address - Street 1:4100 SION FARM
Practice Address - Street 2:SUITE 7
Practice Address - City:ST. CROIX
Practice Address - State:VI
Practice Address - Zip Code:00820
Practice Address - Country:US
Practice Address - Phone:340-713-8397
Practice Address - Fax:340-719-5301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2009-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VI=========OtherEIN