Primary Multispecialty Clinic

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

License

LEO 196 Issued in GU

Legal business name

PRIMARY MULTISPECIALTY CLINIC

Practice address

177 Chalan Pasaheru Ste C
Tamuning, GU 96913-4161

Phone

(671) 647-6201

Fax

(671) 647-0045

NPI assigned

Apr 24, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Therese T. Chong

Title

Patient Relations Coordinator

Phone

(671) 688-1066

Specialties & licenses 1

Addresses

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Florencio Tudela Lizama, M.D.

  • Internal Medicine Physician
  • Tamuning, GU
  • NPI 1538220553
  NPD (past)
• Jessica Garland Joseph, NP-C

  • Family Nurse Practitioner
  • New York, NY
  • NPI 1043440134
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1240531200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1240531200000",
    "number": "1104060839",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "177 CHALAN PASAHERU # A",
            "address_2": "STE F",
            "city": "TAMUNING",
            "state": "GU",
            "postal_code": "969134161",
            "telephone_number": "671-647-6201",
            "fax_number": "671-647-0045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "177 CHALAN PASAHERU STE C",
            "city": "TAMUNING",
            "state": "GU",
            "postal_code": "969134161",
            "telephone_number": "671-647-6201",
            "fax_number": "671-647-0045"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMARY MULTISPECIALTY CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-24",
        "last_updated": "2009-04-24",
        "status": "A",
        "authorized_official_last_name": "CHONG",
        "authorized_official_first_name": "THERESE",
        "authorized_official_middle_name": "T.",
        "authorized_official_title_or_position": "PATIENT RELATIONS COORDINATOR",
        "authorized_official_telephone_number": "671-688-1066"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "GU",
            "license": "LEO 196",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Peachy Mae Tadifa Piana-Pacheco, M.D.
• Rovilmina Pickop, REGISTERED NURSE
• Rory Platt, M.D. A.P.C.
• Peter John Pommerville, BA, MD, FRCSC
• Premise Health Employer Solutions LLC
• Prime Care Inc
• Priority One Transport LLC
• Danica Grace Laborte Pua, RPH
• Celeste Ulanday Punzalan-Almira, RN
• Bannuar Emmanuel Tomboc Quiaoit, FNP

• All providers in Tamuning, GU
• Multi-Specialty Clinic/Center in Guam

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.