Organization
MEDICAL HEALTH &DME SUPPLIES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MAXWELL CLEMENT WILSON (MANAGER/DIRECTOR)
(340) 642-9515
Entity
Organization
Contact information
Practice address
ESTATE CONCORDIA, #112-2, FREDERIKSTED, VI 00840
(340) 719-3845
Mailing address
PO BOX 223762, 100 CHURCH STREET DOWNTOWN STATION, CHRISTIANSTED, VI 00822
(340) 727-3535
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
2-13263-1L
VI
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
2-13263-1L
VI
Other
Enumeration date
11/29/2016
Last updated
11/29/2016
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