Provider Demographics
NPI:1891326070
Name:KAGMAN COMMUNITY HEALTH CENTER INC
Entity Type:Organization
Organization Name:KAGMAN COMMUNITY HEALTH CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:T
Authorized Official - Last Name:CASTRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:670-783-7100
Mailing Address - Street 1:PO BOX 5723
Mailing Address - Street 2:
Mailing Address - City:SAIPAN
Mailing Address - State:MP
Mailing Address - Zip Code:96950-5556
Mailing Address - Country:US
Mailing Address - Phone:670-783-7100
Mailing Address - Fax:670-256-5245
Practice Address - Street 1:5 CANAL STREET
Practice Address - Street 2:
Practice Address - City:TINIAN
Practice Address - State:MP
Practice Address - Zip Code:96952
Practice Address - Country:US
Practice Address - Phone:670-256-5248
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-28
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)