WALTER J M PEDERSEN JR MD PC NPI 1184808065

NPI Information

  • NPI: 1184808065
  • Provider Name: WALTER J M PEDERSEN JR MD PC
  • Classification: Prosthetic/Orthotic Supplier - 335E00000X
  • Entity Type: Organization
  • Address: SUNNY ISLE PROF BLDG
    SUITE 3F
    ST CROIX, VI
    ZIP 00823
  • Phone: (340) 778-6110

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NPI Details

WALTER J M PEDERSEN JR MD PC is a prosthetic orthotic supplier in St Croix, VI. The provider is an organization that provides prosthetic and orthotic care which may include, but is not limited to, patient evaluation, prosthesis or orthosis design, fabrication, fitting and modification to treat limb loss for purposes of restoring physiological function and/or cosmesis or to treat a neuromusculoskeletal disorder or acquired condition. WALTER J M PEDERSEN JR MD PC NPI is 1184808065. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

SUNNY ISLE PROF BLDG
SUITE 3F
ST CROIX, VI
ZIP 00823-423
Phone: (340) 778-6110
Fax: (340) 778-2919

The provider's authorized official is Walter J M Pedersen .
The authorized official title is President and has the following contact phone number (340) 778-6110.

The enumeration date for this NPI number is 12/27/2007 and was last updated on 7/10/2012.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207X00000XOrthopaedic Surgery653VIRGIN ISLANDSNo
2335E00000XProsthetic/Orthotic Supplier653VIRGIN ISLANDSYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1=========OTHERVIRGIN ISLANDSCOMMERCIAL
2VI000011OTHERVIRGIN ISLANDSTRICARE
3G40288MEDICARE UPINVIRGIN ISLANDS
453699PEOTHERVIRGIN ISLANDSTRIPLE-S
54828560001MEDICARE NSCVIRGIN ISLANDS
60500138OTHERVIRGIN ISLANDSHUMANA
71780671909OTHERVIRGIN ISLANDSNPI
80024441MEDICARE PINVIRGIN ISLANDS
9089045OTHERVIRGIN ISLANDSBCBSVI
101184808065OTHERVIRGIN ISLANDSNPI
11170823200OTHERVIRGIN ISLANDSUSDL

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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