Provider Demographics
NPI:1497787113
Name:LBJ TROPICAL MEDICAL CENTER
Entity Type:Organization
Organization Name:LBJ TROPICAL MEDICAL CENTER
Other - Org Name:AMERICAN SAMOA MEDICAL CENTER AUTHORITY
Other - Org Type:Other Name
Authorized Official - Title/Position:ER PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:MANU
Authorized Official - Last Name:AOELUA
Authorized Official - Suffix:
Authorized Official - Credentials:MBBS
Authorized Official - Phone:684-644-2642
Mailing Address - Street 1:PO BOX 2189
Mailing Address - Street 2:
Mailing Address - City:PAGO PAGO
Mailing Address - State:AS
Mailing Address - Zip Code:96799-2189
Mailing Address - Country:US
Mailing Address - Phone:684-644-2642
Mailing Address - Fax:
Practice Address - Street 1:FAGAALU, AMERICAN SAMOA
Practice Address - Street 2:
Practice Address - City:PAGO PAGO
Practice Address - State:AS
Practice Address - Zip Code:96799
Practice Address - Country:US
Practice Address - Phone:684-633-1222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AS2053-A282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
AS$$$$$$$$$OtherSOCIAL SECURITY