Provider Demographics
NPI:1841628682
Name:GUAM URGENT CARE
Entity type:Organization
Organization Name:GUAM URGENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAITANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:671-475-6500
Mailing Address - Street 1:PO BOX 22966
Mailing Address - Street 2:
Mailing Address - City:BARRIGADA
Mailing Address - State:GU
Mailing Address - Zip Code:96921-2966
Mailing Address - Country:US
Mailing Address - Phone:671-632-1447
Mailing Address - Fax:
Practice Address - Street 1:250 ROUTE 4 STE 203
Practice Address - Street 2:NANBO GUAHAN BUILDING
Practice Address - City:HAGATNA
Practice Address - State:GU
Practice Address - Zip Code:96910-7110
Practice Address - Country:US
Practice Address - Phone:671-632-1447
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-14
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty