Provider Demographics
NPI:1083946933
Name:GUAM SURGICENTER, LLC
Entity Type:Organization
Organization Name:GUAM SURGICENTER, LLC
Other - Org Name:ISLAND CANCER CENTER, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:PAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-672-9349
Mailing Address - Street 1:633 GOV CARLOS G CAMACHO RD
Mailing Address - Street 2:GUAM MEDICAL PLAZA SUITE 101
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96913-3194
Mailing Address - Country:US
Mailing Address - Phone:671-646-3855
Mailing Address - Fax:
Practice Address - Street 1:633 GOV CARLOS G CAMACHO RD
Practice Address - Street 2:GUAM MEDICAL PLAZA SUITE 101
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913-3194
Practice Address - Country:US
Practice Address - Phone:671-646-3855
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GUAM SURGICENTER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-02-03
Last Update Date:2010-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0203XAmbulatory Health Care FacilitiesClinic/CenterOncology, Radiation
Provider Identifiers
StateIdentifier IDID TypeIssuer
GUH54135Medicare Oscar/Certification