Provider Demographics
NPI:1841560059
Name:ST CROIX FAMILY MEDICINE, LLC
Entity Type:Organization
Organization Name:ST CROIX FAMILY MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEMAINE
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:OWEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:340-692-2600
Mailing Address - Street 1:RR 2 BOX 10565
Mailing Address - Street 2:SUITE 107, THE VILLAGE MALL
Mailing Address - City:KINGSHILL
Mailing Address - State:VI
Mailing Address - Zip Code:00850-9604
Mailing Address - Country:US
Mailing Address - Phone:340-692-2600
Mailing Address - Fax:340-692-2602
Practice Address - Street 1:4500 SUNNY ISLE
Practice Address - Street 2:
Practice Address - City:CHRISTIANSTED
Practice Address - State:VI
Practice Address - Zip Code:00820-5173
Practice Address - Country:US
Practice Address - Phone:340-692-2600
Practice Address - Fax:340-692-2602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-04
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI2-14663-1L261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care