| Organization Name: | ST CROIX MEDICAL GROUP, INC. |
| NPI Number: | 1346570546 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | HARRY G MARCELIN (OWNER) |
| Mailing Address: | 4050 Nw 34 St Lauderdale Lakes |
| State: | FLORIDA UM |
| Postal Code: | 33319 |
| Phone Number: | 9544867101 |
| Fax Number: | 9544867102 |
| NPI Enumeration Date: | 01/11/2010 |
| NPI Last Update Date: | 05/18/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |