Provider Demographics
NPI:1437705480
Name:SURGICAL CHOICE
Entity Type:Organization
Organization Name:SURGICAL CHOICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE POPRIATOR
Authorized Official - Prefix:
Authorized Official - First Name:OLIVINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:TREASURE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:340-719-9876
Mailing Address - Street 1:PO BOX 4159
Mailing Address - Street 2:
Mailing Address - City:KINGSHILL
Mailing Address - State:VI
Mailing Address - Zip Code:00851-4159
Mailing Address - Country:US
Mailing Address - Phone:340-719-9876
Mailing Address - Fax:
Practice Address - Street 1:4006 ESTATE DIAMOND STE 202
Practice Address - Street 2:
Practice Address - City:CHRISTIANSTED
Practice Address - State:VI
Practice Address - Zip Code:00820-4534
Practice Address - Country:US
Practice Address - Phone:340-719-9876
Practice Address - Fax:340-773-0600
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. CROIX OBGYN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-08-15
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VI1068Medicaid