Provider Demographics
NPI:1285287979
Name:VIRGIN ISLANDS HEALTHCARE FOUNDATION, INC.
Entity type:Organization
Organization Name:VIRGIN ISLANDS HEALTHCARE FOUNDATION, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAN
Authorized Official - Middle Name:BIJAN
Authorized Official - Last Name:TAWAKOL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:340-715-7720
Mailing Address - Street 1:3004 ORANGE GROVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CHRISTIANSTED
Mailing Address - State:VI
Mailing Address - Zip Code:00820-4288
Mailing Address - Country:US
Mailing Address - Phone:340-715-7720
Mailing Address - Fax:340-713-9002
Practice Address - Street 1:3004 ORANGE GROVE
Practice Address - Street 2:SUITE 2
Practice Address - City:CHRISTIANSTED
Practice Address - State:VI
Practice Address - Zip Code:00820-4288
Practice Address - Country:US
Practice Address - Phone:340-715-7720
Practice Address - Fax:340-713-9002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-22
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VIPRVP00000024762Medicaid