Provider Demographics
NPI:1275781171
Name:TRIPLER ARMY MEDICAL CENTER
Entity Type:Organization
Organization Name:TRIPLER ARMY MEDICAL CENTER
Other - Org Name:POHAKULOA TMC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:UBO MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HUGH
Authorized Official - Middle Name:
Authorized Official - Last Name:KEEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-433-1016
Mailing Address - Street 1:1 JARRETT WHITE RD
Mailing Address - Street 2:ATTN PAD MCHK-PAT-T
Mailing Address - City:TRIPLER ARMY MEDICAL CENTER
Mailing Address - State:HI
Mailing Address - Zip Code:96859-5001
Mailing Address - Country:US
Mailing Address - Phone:808-433-6103
Mailing Address - Fax:
Practice Address - Street 1:1 JARRETT WHITE RD
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96859
Practice Address - Country:US
Practice Address - Phone:808-969-2411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRIPLER ARMY MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-04
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1100XAmbulatory Health Care FacilitiesClinic/CenterMilitary/U.S. Coast Guard Outpatient
Provider Identifiers
StateIdentifier IDID TypeIssuer
OTH000Medicare UPIN
VAD000Medicare UPIN