1902160211 NPI number — GUAM MEDICAL HEALTH CARE CENTER, 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 1902160211 NPI number — GUAM MEDICAL HEALTH CARE CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GUAM MEDICAL HEALTH CARE CENTER, 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:
1902160211
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/10/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1757 ARMY DR
Provider Second Line Business Mailing Address:
SUITE 108
Provider Business Mailing Address City Name:
TAMUNING
Provider Business Mailing Address State Name:
GU
Provider Business Mailing Address Postal Code:
96913-1260
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
671-647-4533
Provider Business Mailing Address Fax Number:
671-647-1110

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1757 ARMY DR
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
TAMUNING
Provider Business Practice Location Address State Name:
GU
Provider Business Practice Location Address Postal Code:
96913-1260
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
671-647-4533
Provider Business Practice Location Address Fax Number:
671-647-1110
Provider Enumeration Date:
07/02/2012

Additional Information

Authorized Official

Authorized Official Last Name:
VILLA
Authorized Official First Name:
EDEN
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PHYSICIAN/DIRECTOR
Authorized Official Telephone Number:
671-647-4533

Provider Taxonomy Codes

  • Taxonomy code: 261QH0100X , with the licence number:  M-1705 , registered in the state of GU ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: M1705 , 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)





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