Basic Information
| Provider Information | |||||||||
| NPI: | 1457329849 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AMERICAN MEDICAL CENTER, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1244 NORTH MARINE CORPS DRIVE | ||||||||
| Address2: | |||||||||
| City: | UPPER TUMON | ||||||||
| State: | GU | ||||||||
| PostalCode: | 969134307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6716478262 | ||||||||
| FaxNumber: | 6716478257 | ||||||||
| Practice Location | |||||||||
| Address1: | 1244 NORTH MARINE CORPS DRIVE | ||||||||
| Address2: | |||||||||
| City: | UPPER TUMON | ||||||||
| State: | GU | ||||||||
| PostalCode: | 969134307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6716478262 | ||||||||
| FaxNumber: | 6716478257 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/10/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | NGUYEN | ||||||||
| AuthorizedOfficialFirstName: | HOA | ||||||||
| AuthorizedOfficialMiddleName: | VAN | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6716478262 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | 13-200500483-002 | GU | X | Ambulatory Health Care Facilities | Clinic/Center | 261QM1300X | 13-200500483 | GU | X | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | 261QU0200X | 13-200500483-002 | GU | X | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
No ID Information.