Provider Demographics
NPI:1871862300
Name:EDGAR M. MAGCALAS M.D. PC
Entity Type:Organization
Organization Name:EDGAR M. MAGCALAS M.D. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNHART
Authorized Official - Suffix:
Authorized Official - Credentials:CMRS
Authorized Official - Phone:671-646-5207
Mailing Address - Street 1:PO BOX 7780
Mailing Address - Street 2:
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96931-7780
Mailing Address - Country:US
Mailing Address - Phone:671-646-5207
Mailing Address - Fax:671-646-5226
Practice Address - Street 1:590 S MARINE CORPS DR
Practice Address - Street 2:ITC BUILDING SUITE 226
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913-3507
Practice Address - Country:US
Practice Address - Phone:671-646-5207
Practice Address - Fax:671-646-5226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-29
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUM1345174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GUH77809Medicare UPIN