Provider Demographics
NPI:1194820803
Name:GUAM MEDICAL EQUIPMENT AND SUPPLIES, LLC
Entity Type:Organization
Organization Name:GUAM MEDICAL EQUIPMENT AND SUPPLIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:NIDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:LLAMADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:671-649-4633
Mailing Address - Street 1:353 CHALAN SAN ANTONIO STE 102-B
Mailing Address - Street 2:
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96913-3300
Mailing Address - Country:US
Mailing Address - Phone:671-649-4633
Mailing Address - Fax:671-649-4636
Practice Address - Street 1:353 CHALAN SAN ANTONIO STE 102-B
Practice Address - Street 2:
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913-3300
Practice Address - Country:US
Practice Address - Phone:671-649-4633
Practice Address - Fax:671-649-4636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GU5706030001Medicare NSC