Provider Demographics
NPI:1740238534
Name:GOVERNOR JUAN F. LUIS HOSPITAL & MEDICAL CENTER
Entity Type:Organization
Organization Name:GOVERNOR JUAN F. LUIS HOSPITAL & MEDICAL CENTER
Other - Org Name:ST. CROIX HOSPITAL
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CHIEL FINANCIAL OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:ROSALIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JAVOIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:340-778-6311
Mailing Address - Street 1:4007 ESTATE DIAMOND RUBY
Mailing Address - Street 2:CHRISTIANSTED
Mailing Address - City:ST CROIX
Mailing Address - State:VI
Mailing Address - Zip Code:00820-4435
Mailing Address - Country:US
Mailing Address - Phone:340-778-6311
Mailing Address - Fax:340-778-8038
Practice Address - Street 1:4007 ESTATE DIAMOND RUBY
Practice Address - Street 2:CHRISTIANSTED
Practice Address - City:ST CROIX
Practice Address - State:VI
Practice Address - Zip Code:00820-4435
Practice Address - Country:US
Practice Address - Phone:340-778-6311
Practice Address - Fax:340-778-8038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
VI482302Medicare Oscar/Certification