Organization
EMERGENCY MEDICAL CARE
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
2230 LILIHA ST, HONOLULU, HI 96817-1646
(808) 547-6387
(808) 595-6189
Mailing address
PO BOX 8490, PHILADELPHIA, PA 19101-8490
(800) 355-0808
(215) 834-2862
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009448
—
HI
Enumeration date
10/29/2007
Last updated
04/20/2008
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