Provider Demographics
NPI:1780796375
Name:VI KIDNEY CENTER INC
Entity type:Organization
Organization Name:VI KIDNEY CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WISHBURNE
Authorized Official - Middle Name:I
Authorized Official - Last Name:HUNTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:340-774-1909
Mailing Address - Street 1:PO BOX 10445
Mailing Address - Street 2:
Mailing Address - City:ST THOMAS
Mailing Address - State:VI
Mailing Address - Zip Code:00801-3445
Mailing Address - Country:US
Mailing Address - Phone:340-774-1909
Mailing Address - Fax:340-777-9539
Practice Address - Street 1:9150 ESTATE THOMAS
Practice Address - Street 2:SUITE 208
Practice Address - City:ST THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802
Practice Address - Country:US
Practice Address - Phone:340-774-1909
Practice Address - Fax:340-777-9539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI679207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
E85614Medicare UPIN