Provider Demographics
NPI:1467852749
Name:NAVAL HOSPITAL GUAM
Entity Type:Organization
Organization Name:NAVAL HOSPITAL GUAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL STAFF SERVICES PROFESSIONAL
Authorized Official - Prefix:MR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:K
Authorized Official - Last Name:BALDWIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:6713-449-6798
Mailing Address - Street 1:PSC 490 BOX 9095
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96538-9000
Mailing Address - Country:US
Mailing Address - Phone:671-344-9679
Mailing Address - Fax:
Practice Address - Street 1:PSC 490 BOX 9095
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96538-9000
Practice Address - Country:US
Practice Address - Phone:671-344-9679
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-25
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 11642286500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital