Provider Demographics
NPI:1255338000
Name:GUAM SURGICENTER, LLC
Entity type:Organization
Organization Name:GUAM SURGICENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:671-646-3855
Mailing Address - Street 1:633 CAROLS CAMACHO RD
Mailing Address - Street 2:STE. 101 GUAM MEDICAL PLAZA
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96913-3143
Mailing Address - Country:US
Mailing Address - Phone:671-646-3855
Mailing Address - Fax:671-646-3854
Practice Address - Street 1:633 CAROLS CAMACHO RD
Practice Address - Street 2:STE. 101 GUAM MEDICAL PLAZA
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913-3143
Practice Address - Country:US
Practice Address - Phone:671-646-3855
Practice Address - Fax:671-646-3854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GU0632498261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GU54135Medicare PIN