Provider Demographics
NPI:1770707945
Name:GUAM MEDICAL IMAGING CENTER LLC
Entity type:Organization
Organization Name:GUAM MEDICAL IMAGING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RCM
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:CASE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-887-7775
Mailing Address - Street 1:472 CHALAN SAN ANTONIO
Mailing Address - Street 2:SUITE 111
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96913
Mailing Address - Country:US
Mailing Address - Phone:671-649-9227
Mailing Address - Fax:671-649-9228
Practice Address - Street 1:472 CHALAN SAN ANTONIO
Practice Address - Street 2:SUITE 111
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913
Practice Address - Country:US
Practice Address - Phone:671-649-9227
Practice Address - Fax:671-649-9228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear RadiologyGroup - Multi-Specialty
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
55748Medicare ID - Type Unspecified