Provider Demographics
NPI:1962628305
Name:EMERGENCY MEDICAL SERVICES SYSTEM
Entity Type:Organization
Organization Name:EMERGENCY MEDICAL SERVICES SYSTEM
Other - Org Name:HAWAI'I DEPT OF HEALTH-RURAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-733-8329
Mailing Address - Street 1:PO BOX 269110
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95826-9110
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3627 KILAUEA AVE
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-2317
Practice Address - Country:US
Practice Address - Phone:808-733-8329
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EMERGENCY MEDICAL SERVICES SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-17
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No3416A0800XTransportation ServicesAmbulanceAir Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI523193-01Medicaid
HI590012739OtherRRB
HIH55648Medicare PIN