1285746636 NPI number — CANCER CENTER OF HAWAII, LLC

Table of content: (NPI 1285746636)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285746636 NPI number — CANCER CENTER OF HAWAII, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CANCER CENTER OF HAWAII, LLC
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:
6
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:
1285746636
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2226 LILIHA ST
Provider Second Line Business Mailing Address:
LEVEL B-2
Provider Business Mailing Address City Name:
HONOLULU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96817-1600
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-547-6881
Provider Business Mailing Address Fax Number:
808-547-6583

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2226 LILIHA ST
Provider Second Line Business Practice Location Address:
LEVEL B-2
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96817-1600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-547-6881
Provider Business Practice Location Address Fax Number:
808-547-6583
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BROWN
Authorized Official First Name:
VINCENT
Authorized Official Middle Name:
C
Authorized Official Title or Position:
MANAGER/MEDICAL DIRECTOR
Authorized Official Telephone Number:
808-547-6881

Provider Taxonomy Codes

  • Taxonomy code: 261QX0203X , with the licence number:  RT0007 , 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: 564395 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0000249045 . This is a "HMSA BASIC" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 0000249045 . This is a "HMSA HMO" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: Z1658 . This is a "MDX" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 0000249045 . This is a "HMSA HMO: HI IPA" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 5673407 . This is a "FIRST HEALTH" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 0000249045 . This is a "HMSA QUEST" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 000249045 . This is a "HMSA 65C AND 65C PLUS" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 55593001 . This is a "ALOHACARE" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".




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