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NPI Code Detail

MEDICARE: GUAM SURGICENTER, LLC

MEDICARE: GUAM SURGICENTER, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QA1903XAmbulatory Surgical Clinic/Center0632498GU

General Provider Information

NPI Number : 1255338000
Entity Type Code : Organization
Provider Name (Legal Business Name) : GUAM SURGICENTER, LLC
Provider Business Mailing Address
First Line : 633 CAROLS CAMACHO RD
Second Line : STE. 101 GUAM MEDICAL PLAZA
City : TAMUNING
State : GU
Zip : 96913-3143
Country : US
Telephone Number : 671-646-3855
Fax Number : 671-646-3854
Provider Business Practice Location Address
First Line : 633 CAROLS CAMACHO RD
Second Line : STE. 101 GUAM MEDICAL PLAZA
City : TAMUNING
State : GU
Zip : 96913-3143
Country : US
Telephone Number : 671-646-3855
Fax Number : 671-646-3854
Authorized Official
Title or Position : BOARD MEMBER
Name : DR. JAN BOLLINGER
Credential : M.D.
Telephone Number : 671-646-3855
Provider Enumeration Date : 07/07/2005
Last Update Date : 08/22/2020

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Directions to “GUAM SURGICENTER, LLC ” Practice Location

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