1821223124 NPI number — KONA NPS LLC

Table of content: (NPI 1821223124)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821223124 NPI number — KONA NPS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KONA NPS 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:
1821223124
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/16/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
74-5027 TOMI TOMI DR # A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KAILUA KONA
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96740-8114
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-987-4506
Provider Business Mailing Address Fax Number:
808-326-9071

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
74-5027 TOMI TOMI DR # A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KAILUA KONA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96740-8114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-987-4506
Provider Business Practice Location Address Fax Number:
808-326-9071
Provider Enumeration Date:
05/16/2009

Additional Information

Authorized Official

Authorized Official Last Name:
SOTO
Authorized Official First Name:
RONDA
Authorized Official Middle Name:
K
Authorized Official Title or Position:
MEMBER OWNER
Authorized Official Telephone Number:
808-987-4506

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  APRN 677 , 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: 0000248963 . This is a "HMSA QUEST" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 560616-03 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00A024896-1 . This is a "HMSA - LCCK" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 000024896-3 . This is a "HMSA" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 560616-01 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0394691100 . This is a "UHA" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".




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