Provider Demographics
NPI:1366786865
Name:GUAM MEDICAL EQUIPMENT, LLC
Entity type:Organization
Organization Name:GUAM MEDICAL EQUIPMENT, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:CESAR
Authorized Official - Middle Name:SAYSON
Authorized Official - Last Name:VILLANUEVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:671-788-8200
Mailing Address - Street 1:353 CHALAN SAN ANTONIO
Mailing Address - Street 2:SUITE 102-B PHOTO TOWN PLAZA,
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96913
Mailing Address - Country:US
Mailing Address - Phone:671-649-4633
Mailing Address - Fax:671-649-4636
Practice Address - Street 1:353 CHALAN SAN ANTONIO
Practice Address - Street 2:SUITE 102-B PHOTO TOWN PLAZA,
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913
Practice Address - Country:US
Practice Address - Phone:671-649-4633
Practice Address - Fax:671-649-4636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-21
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GU6743330001Medicare NSC