1336142884 NPI number — THE SURGICAL SUITES LLC

Table of content: (NPI 1336142884)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336142884 NPI number — THE SURGICAL SUITES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE SURGICAL SUITES LLC
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:
FAULKNER INSTITUTE FOR EYE CARE & SURGERY
Provider Other Organization Name Type Code:
4
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:
1336142884
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1100 WARD AVE
Provider Second Line Business Mailing Address:
STE 1001
Provider Business Mailing Address City Name:
HONOLULU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96814-1617
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-531-0127
Provider Business Mailing Address Fax Number:
808-531-0455

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1100 WARD AVE
Provider Second Line Business Practice Location Address:
STE 1001
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96814-1617
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-531-0127
Provider Business Practice Location Address Fax Number:
808-531-0455
Provider Enumeration Date:
05/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
OMPHROY
Authorized Official First Name:
CARLOS
Authorized Official Middle Name:
ANTHONY
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
808-625-5577

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  FSOF-5 , 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: 5516 . This is a "ALOHA CARE" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 022176-2 . This is a "HMSA" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 088307-01 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".




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