1003257585 NPI number — HAWAII COLLEGE OF ORIENTAL MEDICINE

Table of content: (NPI 1003257585)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003257585 NPI number — HAWAII COLLEGE OF ORIENTAL MEDICINE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HAWAII COLLEGE OF ORIENTAL MEDICINE
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:
HICOM FACULTY COMMUNITTY CLINICAL SERVICES
Provider Other Organization Name Type Code:
5
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:
1003257585
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/11/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
93 BANYAN DR STE 10
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HILO
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96720-4632
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
93 BANYAN DR STE 10
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HILO
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96720-4632
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-933-1369
Provider Business Practice Location Address Fax Number:
866-757-2131
Provider Enumeration Date:
07/11/2013

Additional Information

Authorized Official

Authorized Official Last Name:
PETTIS
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
BURTON
Authorized Official Title or Position:
MEDICAL DIRECTOR / DEAN
Authorized Official Telephone Number:
808-981-2790

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , with the licence number:  671 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 171100000X , with the licence number: ACU-1054 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 171100000X , with the licence number: ACU-1056 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 171100000X , with the licence number: ACU-1070 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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