1275920316 NPI number — PMC ISLA HEALTH SYSTEM

Table of content: (NPI 1275920316)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275920316 NPI number — PMC ISLA HEALTH SYSTEM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PMC ISLA HEALTH SYSTEM
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275920316
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/15/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
177-C CHALAN PASAHERU
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAMUNING
Provider Business Mailing Address State Name:
GUAM
Provider Business Mailing Address Postal Code:
96913
Provider Business Mailing Address Country Code:
AX
Provider Business Mailing Address Telephone Number:
671-647-6201
Provider Business Mailing Address Fax Number:
671-647-0045

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
177-C CHALAN PASAHERU
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAMUNING
Provider Business Practice Location Address State Name:
GUAM
Provider Business Practice Location Address Postal Code:
96913
Provider Business Practice Location Address Country Code:
AX
Provider Business Practice Location Address Telephone Number:
671-647-6201
Provider Business Practice Location Address Fax Number:
671-647-0045
Provider Enumeration Date:
04/15/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DOMBROWSKI
Authorized Official First Name:
CHRIS
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
671-647-6201

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  MOO1035 , registered in the state of GU ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)