1164409546 NPI number — JAMES T POWER III MD

Table of content: JAMES T POWER III MD (NPI 1164409546)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164409546 NPI number — JAMES T POWER III MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POWER
Provider First Name:
JAMES
Provider Middle Name:
T
Provider Name Prefix Text:
Provider Name Suffix Text:
III
Provider Credential Text:
MD
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:
1164409546
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/01/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 682
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KAPAAU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96755-0682
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-884-5190
Provider Business Mailing Address Fax Number:
808-884-5196

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
280 HOMEOLU PLACE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KAUNAKAKAI
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96748-0408
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-553-3141
Provider Business Practice Location Address Fax Number:
808-553-3140
Provider Enumeration Date:
12/28/2005

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: 207P00000X , with the licence number:  MD6345 , 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: 51864901 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 121813 . This is a "MEDICARE FQHC" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com