Provider Demographics
NPI:1699825729
Name:PHYSICIANS' ANESTHESIA SERVICE, INC.
Entity Type:Organization
Organization Name:PHYSICIANS' ANESTHESIA SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:REID
Authorized Official - Middle Name:ICHIO
Authorized Official - Last Name:MANAGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-545-1557
Mailing Address - Street 1:321 N KUAKINI ST
Mailing Address - Street 2:SUITE 306
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-2364
Mailing Address - Country:US
Mailing Address - Phone:808-545-1557
Mailing Address - Fax:808-545-5743
Practice Address - Street 1:321 N KUAKINI ST STE 306
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-2360
Practice Address - Country:US
Practice Address - Phone:808-545-1557
Practice Address - Fax:808-545-5743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIHPASMedicare PIN