Provider Demographics
NPI:1275846602
Name:ISLAND MEDICAL SPECIALISTS PC
Entity Type:Organization
Organization Name:ISLAND MEDICAL SPECIALISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:671-646-3855
Mailing Address - Street 1:PO BOX 9220
Mailing Address - Street 2:
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96931-5220
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 PLAZA STE 212
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?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-14
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty