Provider Demographics
NPI:1447683966
Name:GUAM MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:GUAM MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:P
Authorized Official - Last Name:VERGA
Authorized Official - Suffix:
Authorized Official - Credentials:MS, FACHE
Authorized Official - Phone:671-647-2418
Mailing Address - Street 1:850 GOV CARLOS G CAMACHO RD
Mailing Address - Street 2:
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96913-3128
Mailing Address - Country:US
Mailing Address - Phone:671-647-2556
Mailing Address - Fax:671-649-0145
Practice Address - Street 1:850 GOV CARLOS G CAMACHO RD
Practice Address - Street 2:
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913-3128
Practice Address - Country:US
Practice Address - Phone:671-647-2556
Practice Address - Fax:671-649-0145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-20
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GU282N00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GU655000Medicare PIN
GU652300Medicare PIN
GU650001Medicare PIN