1265525984 NPI number — GINGER D LOCKETTE PT

Table of content: GINGER D LOCKETTE PT (NPI 1265525984)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265525984 NPI number — GINGER D LOCKETTE PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOCKETTE
Provider First Name:
GINGER
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

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:
1265525984
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
481-C KAWAILOA ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KAILUA
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96734
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-261-1514
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
354 ULUNIU STREET
Provider Second Line Business Practice Location Address:
SUITE 404
Provider Business Practice Location Address City Name:
KAILUA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96734
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-262-1118
Provider Business Practice Location Address Fax Number:
808-262-0045
Provider Enumeration Date:
10/02/2006

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: 225100000X , with the licence number:  PT1261 , 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: 49959203 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 23071-4 . This is a "TRICARE HNL" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 49959201 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5532318 . This is a "UHA 99-033202002" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 201711 . This is a "HMA" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: B0230710 . This is a "KAI HMSA PPO/HMO/QST/65C" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: B0230710 . This is a "TRICARE KAI" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 23071-4 . This is a "HNL HMSA PPO/HMO/QST/65C" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 49959200 . This is a "ALOHA CARE" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 99-0332020 . This is a "HMAA" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".




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