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

Table of content: (NPI 1902160211)

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: 207R00000X , with the licence number:  M1705 , registered in the state of GU ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • 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" .

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





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