Provider Demographics
NPI:1992822977
Name:CARLOS A. OMPHROY, M.D., INC.
Entity Type:Organization
Organization Name:CARLOS A. OMPHROY, M.D., INC.
Other - Org Name:CARLOS A. OMPHROY, M. D., INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:A
Authorized Official - Last Name:OMPHROY
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:808-625-5577
Mailing Address - Street 1:95-720 LANIKUHANA AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-2985
Mailing Address - Country:US
Mailing Address - Phone:808-625-5577
Mailing Address - Fax:808-625-1221
Practice Address - Street 1:95-720 LANIKUHANA AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:MILILANI
Practice Address - State:HI
Practice Address - Zip Code:96789-2985
Practice Address - Country:US
Practice Address - Phone:808-625-5577
Practice Address - Fax:808-625-1221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIC01766-9OtherHMSA
HI01649901Medicaid
HIC01766-9OtherHMSA
HI0000BDQVBMedicare PIN