Organization
EMERGENCY MEDICAL CARE WEST
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER PROVASNIK (SUPERVISOR OF PROVIDER ENROLLMENT)
(800) 355-0808
Entity
Organization
Contact information
Practice address
91-2141 FORT WEAVER RD, EWA BEACH, HI 96706-1993
(808) 678-7023
(808) 678-7177
Mailing address
PO BOX 8468, PHILADELPHIA, PA 19101-8468
(800) 355-0808
(215) 834-2862
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000078105
BLUE SHIELD
HI
05
—
058772
—
HI
Enumeration date
07/05/2007
Last updated
04/20/2008
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