1134195357 NPI number — CLINICAL LABORATORIES OF HAWAII LLP

Table of content: (NPI 1134195357)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134195357 NPI number — CLINICAL LABORATORIES OF HAWAII LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLINICAL LABORATORIES OF HAWAII LLP
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:
1134195357
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/26/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
33 LANIHULI ST
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:
96720-4142
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-935-4814
Provider Business Mailing Address Fax Number:
808-935-2518

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
91-2135 FORT WEAVER RD
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
EWA BEACH
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96706-1940
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-677-7999
Provider Business Practice Location Address Fax Number:
808-677-0429
Provider Enumeration Date:
02/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PARK
Authorized Official First Name:
ALYSSA
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
808-677-7999

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00T0234082 . This is a "HMSA" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 0052058701 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".




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