Provider Demographics
NPI:1194029306
Name:OFOHA, M.D. CLINIC, LLC.
Entity Type:Organization
Organization Name:OFOHA, M.D. CLINIC, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:O
Authorized Official - Last Name:OFOHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:340-714-5800
Mailing Address - Street 1:PO BOX 12199
Mailing Address - Street 2:
Mailing Address - City:ST THOMAS
Mailing Address - State:VI
Mailing Address - Zip Code:00801-5199
Mailing Address - Country:US
Mailing Address - Phone:340-714-5800
Mailing Address - Fax:
Practice Address - Street 1:9202 VITRACO PARK
Practice Address - Street 2:SUITE 13
Practice Address - City:ST THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802
Practice Address - Country:US
Practice Address - Phone:340-714-5800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-03
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI1046261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center