Provider Demographics
NPI:1205295771
Name:AMERICAN SAMOA MEDICAL CENTER AUTHORITY
Entity type:Organization
Organization Name:AMERICAN SAMOA MEDICAL CENTER AUTHORITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EMERGENCY ROOM PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:FIONA
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAILL
Authorized Official - Suffix:
Authorized Official - Credentials:MBBS
Authorized Official - Phone:684-633-1222
Mailing Address - Street 1:1 TURNER DRIVE
Mailing Address - Street 2:
Mailing Address - City:PAGO PAGO
Mailing Address - State:AS
Mailing Address - Zip Code:96799-0010
Mailing Address - Country:US
Mailing Address - Phone:684-633-1222
Mailing Address - Fax:684-633-2893
Practice Address - Street 1:1 TURNER DRIVE
Practice Address - Street 2:
Practice Address - City:PAGO PAGO
Practice Address - State:AS
Practice Address - Zip Code:96799-0010
Practice Address - Country:US
Practice Address - Phone:684-633-1222
Practice Address - Fax:684-633-2893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-12
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AS2148-C282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural