Provider Demographics
NPI:1902160211
Name:GUAM MEDICAL HEALTH CARE CENTER, INC.
Entity Type:Organization
Organization Name:GUAM MEDICAL HEALTH CARE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:EDEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:VILLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:671-647-4533
Mailing Address - Street 1:1757 ARMY DR
Mailing Address - Street 2:SUITE 108
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96913-1260
Mailing Address - Country:US
Mailing Address - Phone:671-647-4533
Mailing Address - Fax:671-647-1110
Practice Address - Street 1:1757 ARMY DR
Practice Address - Street 2:SUITE 108
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913-1260
Practice Address - Country:US
Practice Address - Phone:671-647-4533
Practice Address - Fax:671-647-1110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-02
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUM1705207R00000X
GUM-1705261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GUG80012Medicare UPIN
GG530AMedicare PIN
G80012Medicare UPIN
GU8B2921Medicare PIN