Provider Demographics
NPI:1376767426
Name:GUAM X-RAY
Entity Type:Organization
Organization Name:GUAM X-RAY
Other - Org Name:GUAM RADIOLOGY CONSULTANTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:BENJAMIN
Authorized Official - Last Name:BERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:671-649-1001
Mailing Address - Street 1:633 GOVERNOR CARLOS G. CAMACHO ROAD
Mailing Address - Street 2:GUAM MEDICAL PLAZA, SUITE 210
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96913-3194
Mailing Address - Country:US
Mailing Address - Phone:671-649-1001
Mailing Address - Fax:671-649-1002
Practice Address - Street 1:633 GOV CARLOS G CAMACHO RD
Practice Address - Street 2:GUAM MEDICAL PLAZA, SUITE 210
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913
Practice Address - Country:US
Practice Address - Phone:671-649-1001
Practice Address - Fax:671-649-1002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GUBF032Medicare PIN
H52218Medicare Oscar/Certification