Provider Demographics
NPI:1851574594
Name:RICARDO B. EUSEBIO, M.D.
Entity Type:Organization
Organization Name:RICARDO B. EUSEBIO, M.D.
Other - Org Name:ISLAND SURGICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:BROWNLEE
Authorized Official - Last Name:EUSEBIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:671-646-0443
Mailing Address - Street 1:633 GOVERNOR CARLOS CAMACHO ROAD
Mailing Address - Street 2:STE. 202
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96913-3143
Mailing Address - Country:US
Mailing Address - Phone:671-646-0443
Mailing Address - Fax:671-646-0440
Practice Address - Street 1:GUAM MEDICAL PLAZA 633 GOVERNOR CARLOS CAMACHO ROAD
Practice Address - Street 2:STE. 202
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913-3143
Practice Address - Country:US
Practice Address - Phone:671-646-0443
Practice Address - Fax:671-646-0440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUM001017208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GUM001017OtherGUAM MEDICAL LICENSE
GU10-M1017AOtherGUAM CONTROLLED SUBSTANCE
GU217Medicaid
GU217Medicaid
GUM001017OtherGUAM MEDICAL LICENSE
GUH51507Medicare PIN