Healthcare Provider Details

I. General information

NPI: 1952770026
Provider Name (Legal Business Name): MEDICRUISER ONSITE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2015
Last Update Date: 11/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 GUILI STREET
SAIPAN MP
96950-1041
US

IV. Provider business mailing address

PO BOX 501041 1 GUILI STREET
SAIPAN MP
96950-1041
US

V. Phone/Fax

Practice location:
  • Phone: 670-285-5507
  • Fax:
Mailing address:
  • Phone: 670-285-5507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. PAUL M GAHLINGER
Title or Position: SOLE MBR
Credential: MD
Phone: 670-285-5507