Basic Information
Provider Information
NPI: 1255641650
EntityType: 2
ReplacementNPI:  
OrganizationName: MISSION PHYSICIAN SERVICES OF HAWAII, LLC
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Mailing Information
Address1: 3220 S PEORIA AVE STE 101
Address2:  
City: TULSA
State: OK
PostalCode: 741052006
CountryCode: US
TelephoneNumber: 9187704441
FaxNumber: 9187129880
Practice Location
Address1: 3220 S PEORIA AVE STE 101
Address2:  
City: TULSA
State: OK
PostalCode: 741052006
CountryCode: US
TelephoneNumber: 9187704441
FaxNumber: 9187129880
Other Information
ProviderEnumerationDate: 10/19/2010
LastUpdateDate: 12/27/2010
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AuthorizedOfficialLastName: WEBB
AuthorizedOfficialFirstName: KEVIN
AuthorizedOfficialMiddleName: M.
AuthorizedOfficialTitleorPosition: PRESIDENT
AuthorizedOfficialTelephone: 9187704441
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: MR.
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Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208D00000X  N193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansGeneral Practice 
207Q00000X  Y193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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