1780127225 NPI number — LINDEN FAMILY MEDICINE CLINIC LLC

Table of content: (NPI 1780127225)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780127225 NPI number — LINDEN FAMILY MEDICINE CLINIC LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LINDEN FAMILY MEDICINE CLINIC LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780127225
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/03/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 HUALANI ST
Provider Second Line Business Mailing Address:
STE 196
Provider Business Mailing Address City Name:
HILO
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96720-4378
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-961-0146
Provider Business Mailing Address Fax Number:
808-969-3378

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 HUALANI ST
Provider Second Line Business Practice Location Address:
STE 196
Provider Business Practice Location Address City Name:
HILO
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96720-4378
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-961-0146
Provider Business Practice Location Address Fax Number:
808-969-3378
Provider Enumeration Date:
12/01/2016

Additional Information

Authorized Official

Authorized Official Last Name:
LINDEN
Authorized Official First Name:
MARGARET
Authorized Official Middle Name:
ROSEMARY
Authorized Official Title or Position:
MANAGER/OWNER
Authorized Official Telephone Number:
808-961-0146

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com