1073653671 NPI number — VAL J. UMPHRESS PH.D.

Table of content: VAL J. UMPHRESS PH.D. (NPI 1073653671)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073653671 NPI number — VAL J. UMPHRESS PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
UMPHRESS
Provider First Name:
VAL
Provider Middle Name:
J.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
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:
1073653671
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/13/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
99-128 AIEA HEIGHTS DR
Provider Second Line Business Mailing Address:
STE 305
Provider Business Mailing Address City Name:
AIEA
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96701-3933
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-488-9288
Provider Business Mailing Address Fax Number:
808-488-9288

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
99-128 AIEA HEIGHTS DR
Provider Second Line Business Practice Location Address:
STE 305
Provider Business Practice Location Address City Name:
AIEA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96701-3933
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-488-9288
Provider Business Practice Location Address Fax Number:
808-487-3106
Provider Enumeration Date:
02/06/2007

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: 103TC0700X , with the licence number:  611 , 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: 4535 . This is a "ALOHA CARE PROVIDER ID" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 634580 . This is a "DESERET MUTUAL PROVIDERID" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 192947 I1 . This is a "HMA PROVIDER ID" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: PSY611 . This is a "QUEENS HEALTHCARE PLAN" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 002684 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0000213314 . This is a "HMSA PROVIDER ID" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 2286575 . This is a "CIGNA BEHAVIORAL HEALTH" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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