Provider Demographics
NPI:1154537298
Name:MARIANAS HEALTH SERVICES, INC
Entity type:Organization
Organization Name:MARIANAS HEALTH SERVICES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:P
Authorized Official - Last Name:DE BELEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:670-233-4646
Mailing Address - Street 1:PO BOX 10003
Mailing Address - Street 2:PMB 1341
Mailing Address - City:SAIPAN
Mailing Address - State:MP
Mailing Address - Zip Code:96950-8903
Mailing Address - Country:US
Mailing Address - Phone:670-233-4646
Mailing Address - Fax:670-233-4648
Practice Address - Street 1:GHIYEGHI ST. SAN JOSE BLDG STE102
Practice Address - Street 2:MARIANAS HEALTH LLC
Practice Address - City:SAIPAN
Practice Address - State:MP
Practice Address - Zip Code:96950-8903
Practice Address - Country:US
Practice Address - Phone:670-233-4646
Practice Address - Fax:670-233-4648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MP10723-0004261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MP3R-032Medicaid
HIEO039AMedicare Oscar/Certification