Provider Demographics
NPI:1558727263
Name:GUAM REGIONAL MEDICAL CITY
Entity Type:Organization
Organization Name:GUAM REGIONAL MEDICAL CITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:ROSELL
Authorized Official - Last Name:PAGADUAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:671-487-3290
Mailing Address - Street 1:PO BOX 5078
Mailing Address - Street 2:
Mailing Address - City:HAGATNA
Mailing Address - State:GU
Mailing Address - Zip Code:96932-8658
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:GRMC 133, ROUTE 3
Practice Address - Street 2:
Practice Address - City:DEDEDO
Practice Address - State:GU
Practice Address - Zip Code:96912
Practice Address - Country:US
Practice Address - Phone:671-645-5500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-11
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUPT124273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit