Provider Demographics
NPI:1487998035
Name:PROMED CLINICS, LLC
Entity type:Organization
Organization Name:PROMED CLINICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:RICKETTS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:340-773-0007
Mailing Address - Street 1:1 ESTATE CANE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:FREDERIKSTED
Mailing Address - State:VI
Mailing Address - Zip Code:00840-4425
Mailing Address - Country:US
Mailing Address - Phone:340-773-0007
Mailing Address - Fax:
Practice Address - Street 1:1 ESTATE CANE
Practice Address - Street 2:SUITE 207,208,209
Practice Address - City:FREDERIKSTED
Practice Address - State:VI
Practice Address - Zip Code:00840-4425
Practice Address - Country:US
Practice Address - Phone:340-773-0007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI2-21364-1L261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center