1568675155 NPI number — MAHLON F HARRIS RT

Table of content: MAHLON F HARRIS RT (NPI 1568675155)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568675155 NPI number — MAHLON F HARRIS RT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARRIS
Provider First Name:
MAHLON
Provider Middle Name:
F
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RT
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:
1568675155
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1502 PENSACOLA ST
Provider Second Line Business Mailing Address:
A-5
Provider Business Mailing Address City Name:
HONOLULU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96822-5817
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-271-5691
Provider Business Mailing Address Fax Number:
808-521-9454

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1502 PENSACOLA ST
Provider Second Line Business Practice Location Address:
A-5
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96822-5817
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-271-5691
Provider Business Practice Location Address Fax Number:
808-521-9454
Provider Enumeration Date:
05/08/2007

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: 2471R0002X , 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: 0000250167 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 55946101 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".




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