1639498967 NPI number — HAWAII LIFE FLIGHT INC.

Table of content: (NPI 1639498967)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639498967 NPI number — HAWAII LIFE FLIGHT INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HAWAII LIFE FLIGHT 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:
HAWAII LIFE FLIGHT
Provider Other Organization Name Type Code:
3
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:
1639498967
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/03/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10888 S 300 W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH JORDAN
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84095-4043
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-619-4900
Provider Business Mailing Address Fax Number:
801-619-8077

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
150 LAGOON DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96819
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-619-4900
Provider Business Practice Location Address Fax Number:
801-983-6052
Provider Enumeration Date:
05/26/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
THOMAS
Authorized Official First Name:
ERIC
Authorized Official Middle Name:
Authorized Official Title or Position:
SVP OF REVENUE MANAGEMENT
Authorized Official Telephone Number:
877-288-5340

Provider Taxonomy Codes

  • Taxonomy code: 3416A0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3416A0800X , with the licence number: 12-008 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3416A0800X , with the licence number: 17-010 , 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: 644684 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".