1821099144 NPI number — HAWAII CARDIOLOGY, INC

Table of content: (NPI 1821099144)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821099144 NPI number — HAWAII CARDIOLOGY, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HAWAII CARDIOLOGY, 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:
1821099144
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/09/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1425 LILIHA ST
Provider Second Line Business Mailing Address:
SUITE 12
Provider Business Mailing Address City Name:
HONOLULU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96817-3522
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-540-1530
Provider Business Mailing Address Fax Number:
808-356-0424

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
65-1230 MAMALAHOA HWY
Provider Second Line Business Practice Location Address:
SUITE D10
Provider Business Practice Location Address City Name:
KAMUELA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96743-8318
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-887-6410
Provider Business Practice Location Address Fax Number:
808-356-0424
Provider Enumeration Date:
08/09/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SHIKUMA
Authorized Official First Name:
NEAL
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
808-887-6410

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  MD-4389 , 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: 00T0011522 . This is a "HMSA" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: DA8723 . This is a "RR MEDICARE" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 00Q0011521 . This is a "HMSA" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 01103203 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00R0011529 . This is a "HMSA" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 00T0011522 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 00Q0011521 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 01103201 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00R0011529 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 01103207 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".




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