1659442218 NPI number — DR. THOMAS STENNIS BEARDEN PH.D.

Table of content: DR. THOMAS STENNIS BEARDEN PH.D. (NPI 1659442218)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659442218 NPI number — DR. THOMAS STENNIS BEARDEN PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BEARDEN
Provider First Name:
THOMAS
Provider Middle Name:
STENNIS
Provider Name Prefix Text:
DR.
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:
1659442218
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/17/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 AUPUNI ST
Provider Second Line Business Mailing Address:
SUITE 1014 A-2
Provider Business Mailing Address City Name:
HILO
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96720-4246
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-935-2605
Provider Business Mailing Address Fax Number:
808-935-2650

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 AUPUNI ST
Provider Second Line Business Practice Location Address:
SUITE 1014 A-2
Provider Business Practice Location Address City Name:
HILO
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96720-4246
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-935-2605
Provider Business Practice Location Address Fax Number:
808-935-2650
Provider Enumeration Date:
11/13/2006

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:  PSY 888 , 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: 0000252676 . This is a "HMSA PROVIDER NUMBER" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 57172001 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".




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