1215982616 NPI number — DR. JEFFREY WINSTON CUMES PHD

Table of content: DR. JEFFREY WINSTON CUMES PHD (NPI 1215982616)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215982616 NPI number — DR. JEFFREY WINSTON CUMES PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CUMES
Provider First Name:
JEFFREY
Provider Middle Name:
WINSTON
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD
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:
1215982616
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/25/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1323
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KEALAKEKUA
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96750-1323
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-323-9510
Provider Business Mailing Address Fax Number:
808-323-9703

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
81-6587 MAMALAHOA HWY
Provider Second Line Business Practice Location Address:
BLDG C #23
Provider Business Practice Location Address City Name:
KEALAKEKUA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96750-8133
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-323-9510
Provider Business Practice Location Address Fax Number:
808-323-9703
Provider Enumeration Date:
05/23/2006

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:  PSY388 , 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: 04952101 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 56341 . This is a "HMSA ID" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".




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