1699856286 NPI number — PANIOLO COUNTRY PEDIATRICS LLC

Table of content: (NPI 1699856286)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699856286 NPI number — PANIOLO COUNTRY PEDIATRICS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PANIOLO COUNTRY PEDIATRICS 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:
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:
1699856286
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/22/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6149
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KAMUELA
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96743-6149
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-887-6543
Provider Business Mailing Address Fax Number:
808-887-6294

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
64-1032 MAMALAHOA HWY STE 204
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KAMUELA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96743-8441
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-887-6543
Provider Business Practice Location Address Fax Number:
808-887-6294
Provider Enumeration Date:
10/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LEE
Authorized Official First Name:
ROSS
Authorized Official Middle Name:
P
Authorized Official Title or Position:
BUSINESS ADMINISTRATOR
Authorized Official Telephone Number:
808-887-6543

Provider Taxonomy Codes

  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0000235200 . This is a "QHMS, DR. KAPLAN" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 50529001 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 50672701 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: A004 . This is a "CHAMPUS, DR. KAPLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00226101 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3573421 . This is a "UHA, DR. KAPLAN" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 9587421 . This is a "UHA, DR. GREGG" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 0000227603 . This is a "QHMS, DR. LEE" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 00A0211829 . This is a "QHMS, DR. GREGG" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: A003 . This is a "CHAMPUS, DR. LEE" identifier . This identifiers is of the category "OTHER".
  • Identifier: A21182 . This is a "HSMA, DR. GREGG" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 022760 . This is a "HMSA, DR. LEE" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 2314421 . This is a "UHA, DR. LEE" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: A002 . This is a "CHAMPUS, DR. GREGG" identifier . This identifiers is of the category "OTHER".
  • Identifier: 023520 . This is a "HMSA, DR. KAPLAN" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".




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