1134482755 NPI number — MATTHEW PHILIP JOHNSTON ARNP

Table of content: MATTHEW PHILIP JOHNSTON ARNP (NPI 1134482755)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134482755 NPI number — MATTHEW PHILIP JOHNSTON ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSTON
Provider First Name:
MATTHEW
Provider Middle Name:
PHILIP
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
M

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:
1134482755
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/18/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
75-5751 KUAKINI HWY STE 203
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KAILUA KONA
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96740-1753
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-333-3600
Provider Business Mailing Address Fax Number:
808-961-5167

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1178 KINOOLE ST
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:
96720-7206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
83-338-3600
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/19/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  3007618 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP2300X , with the licence number: 3540 , 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: 7100215240 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000781639 . This is a "BCBS WALMART MILLE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: P01105256 . This is a "RR MEDICARE-BAPTIST HEALTH MADISONVILLE INC" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000781754 . This is a "BCBS TROVER" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 3540 . This is a "APRN LICENSE" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".




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