Basic Information
| Provider Information | |||||||||
| NPI: | 1114230109 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TRIPLER ARMY MEDICAL CENTER | ||||||||
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| OtherOrganizationName: | WARRIOR OHANA MEDICAL HOME-SHAFTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 JARRETT WHITE RD | ||||||||
| Address2: | ATTN PAD MCHK-PAT-T - UNIFORM BUSINESS OFFICE | ||||||||
| City: | TRIPLER ARMY MEDICAL CENTER | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968595001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8084336103 | ||||||||
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| Practice Location | |||||||||
| Address1: | 91-1010 SHANGRILA ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | KAPOLEI | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967072161 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8084333418 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2010 | ||||||||
| LastUpdateDate: | 12/18/2012 | ||||||||
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| AuthorizedOfficialLastName: | KEEL | ||||||||
| AuthorizedOfficialFirstName: | HUGH | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRMC UBO | ||||||||
| AuthorizedOfficialTelephone: | 8084331016 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | TRIPLER ARMY MEDICAL CENTER | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1100X | Y | Ambulatory Health Care Facilities | Clinic/Center | Military/U.S. Coast Guard Outpatient |
ID Information
| ID | Type | State | Issuer | Description | 1831146281 | 01 | PARENT BILLING NPI | OTHER |