1639124654 NPI number — PT HAWAII, INC

Table of content: (NPI 1639124654)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639124654 NPI number — PT HAWAII, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PT HAWAII, INC
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:
1639124654
Entity Type Code:
Organization
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:
91-2135 FORT WEAVER ROAD
Provider Second Line Business Mailing Address:
SUITE 170
Provider Business Mailing Address City Name:
EWA BEACH
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96706-1929
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-676-5331
Provider Business Mailing Address Fax Number:
808-671-2931

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
91-2139 FORT WEAVER RD
Provider Second Line Business Practice Location Address:
202
Provider Business Practice Location Address City Name:
EWA BEACH
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96706-3607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-677-5110
Provider Business Practice Location Address Fax Number:
808-671-2931
Provider Enumeration Date:
05/24/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GROVER
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
H
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
808-227-4900

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT2025 , 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: 0000231688 . This is a "HMSA QUEST" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 00A0231686 . This is a "BCBS/HMSA" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 52633701 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0000231688 . This is a "HMSA 65C" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".