1104983733 NPI number — ANALYTIC LAB SYSTEMS INC

Table of content: (NPI 1104983733)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104983733 NPI number — ANALYTIC LAB SYSTEMS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANALYTIC LAB SYSTEMS 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:
1104983733
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/18/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1024 PIIKOI STREET
Provider Second Line Business Mailing Address:
PIIKOI MEDICAL BUILDING
Provider Business Mailing Address City Name:
HONOLULU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96814-1925
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-591-2844
Provider Business Mailing Address Fax Number:
808-591-2840

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1024 PIIKOI STREET
Provider Second Line Business Practice Location Address:
PIIKOI MEDICAL BUILDING
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96814-1925
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-591-2844
Provider Business Practice Location Address Fax Number:
808-591-2840
Provider Enumeration Date:
01/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
OYAMA
Authorized Official First Name:
STANLEY
Authorized Official Middle Name:
N
Authorized Official Title or Position:
LABORATORY DIRECTOR
Authorized Official Telephone Number:
808-591-2844

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  12D0620951 , 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: 02395701 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00026641 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".




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