Provider Demographics
NPI:1174225486
Name:KAGMAN COMMUNITY HEALTH CENTER, INC.
Entity type:Organization
Organization Name:KAGMAN COMMUNITY HEALTH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:T
Authorized Official - Last Name:CASTRO
Authorized Official - Suffix:
Authorized Official - Credentials:CHCEF
Authorized Official - Phone:670-256-5248
Mailing Address - Street 1:PO BOX 5723 CHRB
Mailing Address - Street 2:
Mailing Address - City:SAIPAN
Mailing Address - State:MP
Mailing Address - Zip Code:96950-5556
Mailing Address - Country:US
Mailing Address - Phone:670-256-5242
Mailing Address - Fax:670-256-5244
Practice Address - Street 1:856 CHALAN TUN THOMAS P. SABLAN SAN ANTONIO
Practice Address - Street 2:
Practice Address - City:SAIPAN
Practice Address - State:MP
Practice Address - Zip Code:96950-5556
Practice Address - Country:US
Practice Address - Phone:670-256-5242
Practice Address - Fax:670-256-5244
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KAGMAN COMMUNITY HEALTH CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)