Provider Demographics
NPI:1164842050
Name:FREDERIKSTED HEALTH CARE, INC.
Entity Type:Organization
Organization Name:FREDERIKSTED HEALTH CARE, INC.
Other - Org Name:NORTH SHORE HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MASSERAE
Authorized Official - Middle Name:E
Authorized Official - Last Name:SPRAUVE-WEBSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:340-772-1992
Mailing Address - Street 1:PO BOX 1198
Mailing Address - Street 2:
Mailing Address - City:FREDERIKSTED
Mailing Address - State:VI
Mailing Address - Zip Code:00841-1198
Mailing Address - Country:US
Mailing Address - Phone:340-772-0260
Mailing Address - Fax:340-772-5895
Practice Address - Street 1:6C ESTATE LA GRANDE PRINCESSE
Practice Address - Street 2:
Practice Address - City:CHRISTIANSTED
Practice Address - State:VI
Practice Address - Zip Code:00820-4328
Practice Address - Country:US
Practice Address - Phone:340-772-0260
Practice Address - Fax:340-718-1090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-18
Last Update Date:2014-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI481801Medicare PIN
FLDA080AMedicare PIN