1740641513 NPI number — HAWAII FOOT AND ANKLE SURGICAL SPECIALISTS, LLC

Table of content: (NPI 1740641513)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740641513 NPI number — HAWAII FOOT AND ANKLE SURGICAL SPECIALISTS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HAWAII FOOT AND ANKLE SURGICAL SPECIALISTS, 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:
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:
1740641513
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/08/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1028 KINOOLE ST
Provider Second Line Business Mailing Address:
SUITE 104
Provider Business Mailing Address City Name:
HILO
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96720-3800
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-935-3121
Provider Business Mailing Address Fax Number:
808-443-0400

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1028 KINOOLE ST
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
HILO
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96720-3800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-935-3121
Provider Business Practice Location Address Fax Number:
808-443-0400
Provider Enumeration Date:
03/08/2016

Additional Information

Authorized Official

Authorized Official Last Name:
MCLEOD
Authorized Official First Name:
MISAKO
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
415-302-0239

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , 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)





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