1093840894 NPI number — DR SUSAN HALL INC

Table of content: (NPI 1093840894)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093840894 NPI number — DR SUSAN HALL INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR SUSAN HALL INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093840894
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 26049
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HONOLULU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96825-6049
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-394-6206
Provider Business Mailing Address Fax Number:
808-394-6207

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4566 OHIA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KAPAA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96746-1646
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-651-4860
Provider Business Practice Location Address Fax Number:
808-822-7048
Provider Enumeration Date:
02/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HALL
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
808-394-6206

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  PSY377 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 52102205 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00F0235942 . This is a "HAWAII MEDICAL SVC ASSN" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".




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