Provider Demographics
NPI:1972503647
Name:GOVERNOR JUAN F. LUIS HOSPITAL & MEDICAL CENTER
Entity type:Organization
Organization Name:GOVERNOR JUAN F. LUIS HOSPITAL & MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:J
Authorized Official - Last Name:CALLISTE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD,FACHE
Authorized Official - Phone:340-778-6311
Mailing Address - Street 1:#4007 ESTATE DIAMOND RUBY
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSTED, ST. CROIX
Mailing Address - State:VI
Mailing Address - Zip Code:00821-4421
Mailing Address - Country:US
Mailing Address - Phone:340-778-6311
Mailing Address - Fax:340-772-7357
Practice Address - Street 1:#4007 ESTATE DIAMOND RUBY
Practice Address - Street 2:
Practice Address - City:CHRISTIANSTED, ST. CROIX
Practice Address - State:VI
Practice Address - Zip Code:00821-4421
Practice Address - Country:US
Practice Address - Phone:340-778-6311
Practice Address - Fax:340-772-7357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
VI47460Medicaid
VI480002Medicare Oscar/Certification
VI0085237Medicare PIN