Provider Demographics
NPI:1659452290
Name:ST. CROIX ORTOPEDIC SUPPLY CENTER
Entity Type:Organization
Organization Name:ST. CROIX ORTOPEDIC SUPPLY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELICA
Authorized Official - Middle Name:R
Authorized Official - Last Name:SCHUSTER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:340-778-6530
Mailing Address - Street 1:PO BOX 1799
Mailing Address - Street 2:
Mailing Address - City:KINGSHILL
Mailing Address - State:VI
Mailing Address - Zip Code:00851-1799
Mailing Address - Country:US
Mailing Address - Phone:340-778-6530
Mailing Address - Fax:340-778-4922
Practice Address - Street 1:201-202 ESTATE RUBY
Practice Address - Street 2:
Practice Address - City:CHRISTIANSTED
Practice Address - State:VI
Practice Address - Zip Code:00820
Practice Address - Country:US
Practice Address - Phone:340-778-6530
Practice Address - Fax:340-778-4922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI2-2022938-2006332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VI0624210001Medicare UPIN