Provider Demographics
NPI:1386855906
Name:ACADEMY FOOT CENTER OF HAWAII, INC
Entity Type:Organization
Organization Name:ACADEMY FOOT CENTER OF HAWAII, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:D
Authorized Official - Last Name:PASCUAL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:808-536-4335
Mailing Address - Street 1:1329 LUSITANA ST
Mailing Address - Street 2:SUITE 801
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2429
Mailing Address - Country:US
Mailing Address - Phone:808-536-4335
Mailing Address - Fax:808-537-9195
Practice Address - Street 1:1329 LUSITANA ST
Practice Address - Street 2:SUITE 801
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2429
Practice Address - Country:US
Practice Address - Phone:808-536-4335
Practice Address - Fax:808-537-9195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0888690001Medicare NSC
HIH50749Medicare PIN