Provider Demographics
NPI:1053567883
Name:ACUTE ALTERNATIVE MEDICAL GROUP
Entity type:Organization
Organization Name:ACUTE ALTERNATIVE MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LYN
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:340-772-2883
Mailing Address - Street 1:184C ESTATE DIAMOND RUBY
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSTED
Mailing Address - State:VI
Mailing Address - Zip Code:00820-4424
Mailing Address - Country:US
Mailing Address - Phone:340-772-2883
Mailing Address - Fax:
Practice Address - Street 1:4000 DIAMOND RUBY SUITE 3
Practice Address - Street 2:
Practice Address - City:CHRISTIANSTED
Practice Address - State:VI
Practice Address - Zip Code:00820-4414
Practice Address - Country:US
Practice Address - Phone:340-772-2883
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-12
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI1144207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VI0059804Medicare PIN