Ac Micro Guam LLC
Organization Active NPI Anesthesiology Physician · Tamuning, GU
NPI 1699768093 · NPPES record last updated Aug 10, 2020
Key facts
- NPI
- 1699768093
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Anesthesiology Physician 207L00000X
- License
- 0633184 (GU)
- Legal business name
- AC MICRO GUAM LLC
- Practice address
- 633 Gov Carlos G Camacho Rd
Ste 101 Guam Medical Plaza
Tamuning, GU 96913-3143 - Phone
- (671) 646-3855
- Fax
- (671) 646-3854
- NPI assigned
- Aug 31, 2005
- Organization subpart
- No
Authorized official
- Name
- Mrs. Melissa Waibel
- Title
- Administrator
- Phone
- (671) 646-3855
Member of 1
Practitioners 13
-
Dianna R Gibson, C.R.N.A
-
Page O Kimball, CRNA
-
Hyo Sang Ji, M.D.
-
Gilbert M Lopez, MD
-
Allison Jane Lofton, CRNA
-
Shannon Marie McCrory, CRNA
-
Kit Y NG, CRNA
-
Rikki Marie Truax, CRNA
-
Woonjeong Banks, CRNA
-
Susan Gale Dobbs, MD
-
Ramona M Domen, CRNA
-
John Rosoff, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GU
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20170911002844 | GU | Part B Supplier - Clinic/Group Practice | 9133021710 |
Receives reassigned benefits from 12 practitioners Practice locations: Tamuning, GU |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician |
207L00000X | 0633184 | GU | Yes |
Addresses
Primary practice location
633 Gov Carlos G Camacho Rd
Ste 101 Guam Medical Plaza
Tamuning, GU 96913-3143
Mailing address
633 Gov Carlos G Camacho Rd
Ste 101 Guam Medical Plaza
Tamuning, GU 96913-3143
Phone (671) 646-3855
Other providers in Tamuning, GU
- Evert Vitorio Abit Abear
- Access Medical Transport
- Access Medical, Inc.
- Active Life Chiropractic and Physical Therapy
- Adult Health Care Clinic LLC
- Margie A Agahan
All providers in Tamuning, GU · Anesthesiology Physician in Guam
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 10, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.