Provider Demographics
NPI:1629213749
Name:AMERICAN SAMOA MEDICAL CENTER
Entity Type:Organization
Organization Name:AMERICAN SAMOA MEDICAL CENTER
Other - Org Name:LBJ TROPICAL MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SEFANAIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:KAUMAITOTOYA
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
Mailing Address - Country:US
Mailing Address - Phone:684-633-1222
Mailing Address - Fax:684-633-5107
Practice Address - Street 1:LBJ
Practice Address - Street 2:BOX
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:684-633-5107
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMERICAN SAMOA GOVERNMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-03
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
282N00000X
ASLBJ96799282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
AS640001Medicare Oscar/Certification