Provider Demographics
NPI:1104216977
Name:AMERICAN SAMOA MEDICAL CENTER
Entity Type:Organization
Organization Name:AMERICAN SAMOA MEDICAL CENTER
Other - Org Name:LBJ TROPICAL MEDICAL CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAPI
Authorized Official - Middle Name:EMAU
Authorized Official - Last Name:AMOSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:684-633-1222
Mailing Address - Street 1:PO BOX LBJ
Mailing Address - Street 2:
Mailing Address - City:PAGO PAGO
Mailing Address - State:AS
Mailing Address - Zip Code:96799-0010
Mailing Address - Country:US
Mailing Address - Phone:684-633-1222
Mailing Address - Fax:684-633-1896
Practice Address - Street 1:999 TURNER DRIVE
Practice Address - Street 2:
Practice Address - City:PAGO PAGO
Practice Address - State:AS
Practice Address - Zip Code:96799-0010
Practice Address - Country:US
Practice Address - Phone:684-633-1222
Practice Address - Fax:684-633-1896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-30
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AS2203C282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital