1710056825 NPI number — ORTHOPEDIC CARE HI, INC.

Table of content: (NPI 1710056825)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710056825 NPI number — ORTHOPEDIC CARE HI, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORTHOPEDIC CARE HI, 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:
THE BRACE SHOP
Provider Other Organization Name Type Code:
3
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:
1710056825
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/01/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
627 SOUTH ST STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HONOLULU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96813-5050
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-695-6470
Provider Business Mailing Address Fax Number:
808-695-6499

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
627 SOUTH ST STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96813-5050
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-695-6470
Provider Business Practice Location Address Fax Number:
808-695-6499
Provider Enumeration Date:
11/06/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LUM
Authorized Official First Name:
FRANDEE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/MANAGER
Authorized Official Telephone Number:
808-695-6470

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: DME-0194 . This is a "DURABLE MEDICAL EQUIPMENT LICENSE" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: GE-210-870-6816-01 . This is a "HAWAII TAX ID" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".