Healthcare Provider Details

I. General information

NPI: 1306039698
Provider Name (Legal Business Name): AMERICAN SAMOA MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2007
Last Update Date: 02/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LBJ BOX
PAGO PAGO AS
96799
US

IV. Provider business mailing address

PO BOX LBJ
PAGO PAGO AS
96799
US

V. Phone/Fax

Practice location:
  • Phone: 684-633-1222
  • Fax: 684-633-5107
Mailing address:
  • Phone: 684-633-1222
  • Fax: 684-633-5107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberAS967
License Number StateAS

VIII. Authorized Official

Name: MIKE GERSTENBERGER
Title or Position: CEO
Credential: FACHE
Phone: 684-633-1222