Basic Information
| Provider Information | |||||||||
| NPI: | 1326350406 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MEDICAL ANESTHESIA, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 17128 | ||||||||
| Address2: | |||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968170128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8667266441 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1301 PUNCHBOWL ST | ||||||||
| Address2: | C/O MEDICAL STAFF - ANESTHESIA | ||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968132402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8667266644 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2010 | ||||||||
| LastUpdateDate: | 07/06/2010 | ||||||||
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| AuthorizedOfficialLastName: | CHOCK | ||||||||
| AuthorizedOfficialFirstName: | CLIFFORD | ||||||||
| AuthorizedOfficialMiddleName: | KW | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8667266441 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | MD802 | HI | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.