Walter J M Pedersen Jr MD PC

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

License

653 Issued in VI

Legal business name

WALTER J M PEDERSEN JR MD PC

Practice address

Sunny Isle Prof BLDG
Suite 3F
St Croix, VI 00823-4423

Phone

(340) 778-6110

Fax

(340) 778-2919

NPI assigned

Dec 27, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Walter J M Pedersen Jr., MD

Title

President

Phone

(340) 778-6110

Specialties & licenses 2

Addresses

Other identifiers 7

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1198713600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1341878400000",
    "number": "1184808065",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7840",
            "city": "CHRISTIANSTED",
            "state": "VI",
            "postal_code": "008237840",
            "telephone_number": "340-778-6110",
            "fax_number": "340-778-2919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "SUNNY ISLE PROF BLDG",
            "address_2": "SUITE 3F",
            "city": "ST CROIX",
            "state": "VI",
            "postal_code": "008234423",
            "telephone_number": "340-778-6110",
            "fax_number": "340-778-2919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALTER J M PEDERSEN JR MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-27",
        "last_updated": "2012-07-10",
        "status": "A",
        "authorized_official_last_name": "PEDERSEN",
        "authorized_official_first_name": "WALTER",
        "authorized_official_middle_name": "J M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "340-778-6110",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery",
            "state": "VI",
            "license": "653",
            "primary": false
        },
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "VI",
            "license": "653",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "VI000011",
            "state": "VI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HUMANA",
            "identifier": "0500138",
            "state": "VI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "USDL",
            "identifier": "170823200",
            "state": "VI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1780671909",
            "state": "VI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRIPLE-S",
            "identifier": "53699PE",
            "state": "VI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSVI",
            "identifier": "089045",
            "state": "VI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1184808065",
            "state": "VI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sea View Healthcare Services, Inc.
• St Croix Gastroenterology Center LLC
• St. Thomas Radiology Associates, LLC (St. Croix MRI/CT)
• Taino Wholelife Healthcare, LLC
• Jurene Walcott, RPH
• Robert Williamson, RPH

• Prosthetic/Orthotic Supplier in St Croix, VI
• Providers in St Croix, VI by specialty
• Prosthetic/Orthotic Supplier in U.S. Virgin Islands

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.