Provider Demographics
NPI:1770789331
Name:BRANCH MEDICAL CLINIC GUAM
Entity type:Organization
Organization Name:BRANCH MEDICAL CLINIC GUAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUMED UBO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:CONDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-401-3643
Mailing Address - Street 1:PSC 455 BOX 208
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96540-0003
Mailing Address - Country:US
Mailing Address - Phone:671-344-9242
Mailing Address - Fax:
Practice Address - Street 1:BUILDING 6 CHAPEL ROAD
Practice Address - Street 2:
Practice Address - City:SANTA RITA
Practice Address - State:GU
Practice Address - Zip Code:96538
Practice Address - Country:US
Practice Address - Phone:671-339-7118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NAVAL HOSPITAL GUAM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-21
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1100XAmbulatory Health Care FacilitiesClinic/CenterMilitary/U.S. Coast Guard Outpatient