Provider Demographics
NPI:1306317060
Name:ELEANOR QUINITCHETE HYPERBARIC, WOUND CARE AND DIAGNOSTIC CENTER, INC
Entity type:Organization
Organization Name:ELEANOR QUINITCHETE HYPERBARIC, WOUND CARE AND DIAGNOSTIC CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IAN
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:340-626-3714
Mailing Address - Street 1:4100 SION FARM COMM CTR #8
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSTED
Mailing Address - State:VI
Mailing Address - Zip Code:00820-4433
Mailing Address - Country:US
Mailing Address - Phone:340-626-3714
Mailing Address - Fax:877-349-0205
Practice Address - Street 1:4100 SION FARM COMM CTR #8
Practice Address - Street 2:
Practice Address - City:CHRISTIANSTED
Practice Address - State:VI
Practice Address - Zip Code:00820-4433
Practice Address - Country:US
Practice Address - Phone:340-626-3714
Practice Address - Fax:877-349-0205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-06
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VI1058OtherDEPARTMENT OF HEALTH