Provider Demographics
NPI:1467503433
Name:THE DOCTORS CLINIC
Entity Type:Organization
Organization Name:THE DOCTORS CLINIC
Other - Org Name:FAMILY MEDICAL CLINIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:BENNY
Authorized Official - Middle Name:M
Authorized Official - Last Name:PAULINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:671-647-5212
Mailing Address - Street 1:PO BOX 11409
Mailing Address - Street 2:
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96931-1409
Mailing Address - Country:US
Mailing Address - Phone:671-647-5212
Mailing Address - Fax:671-647-5279
Practice Address - Street 1:851 GOVERNOR CARLOS CAMACHO ROAD
Practice Address - Street 2:
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913-3153
Practice Address - Country:US
Practice Address - Phone:671-648-2711
Practice Address - Fax:671-646-3639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GUHTDC1Medicare PIN