Healthcare Provider Details

I. General information

NPI: 1235081944
Provider Name (Legal Business Name): BHC CAMP BLAZ-GUAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2026
Last Update Date: 02/13/2026
Certification Date: 02/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 455 BOX 208
FPO AP
96540-0003
US

IV. Provider business mailing address

PSC 455
FPO AP
96540
US

V. Phone/Fax

Practice location:
  • Phone: 671-344-9202
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1100X
TaxonomyMilitary/U.S. Coast Guard Outpatient Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM MICHAEL CONDON
Title or Position: DHA UBO
Credential:
Phone: 240-401-3643