1841581055 NPI number — MARIANAS MEDICAL CENTER LABORATORY INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841581055 NPI number — MARIANAS MEDICAL CENTER LABORATORY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARIANAS MEDICAL CENTER LABORATORY INC
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:
1841581055
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/21/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5006
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAIPAN
Provider Business Mailing Address State Name:
MP
Provider Business Mailing Address Postal Code:
96950-5006
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
670-234-3925
Provider Business Mailing Address Fax Number:
670-234-3950

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BEACH ROAD, GARAPAN
Provider Second Line Business Practice Location Address:
2ND FLOOR MMC BLDG.
Provider Business Practice Location Address City Name:
SAIPAN
Provider Business Practice Location Address State Name:
MP
Provider Business Practice Location Address Postal Code:
96950-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
670-234-3925
Provider Business Practice Location Address Fax Number:
670-234-3950
Provider Enumeration Date:
04/21/2011

Additional Information

Authorized Official

Authorized Official Last Name:
VILLAGOMEZ
Authorized Official First Name:
ANGELINA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
SECRETARY OF THE CORPORATION
Authorized Official Telephone Number:
670-234-3925

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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