Provider Demographics
NPI:1619154572
Name:HICKAM FIRE EMERGENCY SERVICES
Entity Type:Organization
Organization Name:HICKAM FIRE EMERGENCY SERVICES
Other - Org Name:HICKAM FIRE DEPARTMENT
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ASSISTANT FIRE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:GARRIGAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:PARAMEDIC SUPERVISOR
Authorized Official - Phone:808-449-8131
Mailing Address - Street 1:345 MAMIYA AVE
Mailing Address - Street 2:HICKAM FIRE DEPARTMENT
Mailing Address - City:HICKAM
Mailing Address - State:HI
Mailing Address - Zip Code:96853-5233
Mailing Address - Country:US
Mailing Address - Phone:808-449-8131
Mailing Address - Fax:808-449-8199
Practice Address - Street 1:345 MAMIYA AVENUE
Practice Address - Street 2:
Practice Address - City:HICKAM
Practice Address - State:HI
Practice Address - Zip Code:96853-5233
Practice Address - Country:US
Practice Address - Phone:808-449-8131
Practice Address - Fax:808-449-8199
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:15TH CIVIL ENGINEER SQUADRON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-23
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management