Provider Demographics
NPI:1831321454
Name:WEST MED CORP
Entity type:Organization
Organization Name:WEST MED CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:NORDYKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-232-9930
Mailing Address - Street 1:1750 KALAKAUA AVE
Mailing Address - Street 2:SUITE 103-3130
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-3766
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1750 KALAKAUA AVE
Practice Address - Street 2:SUITE 103-3130
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-3766
Practice Address - Country:US
Practice Address - Phone:808-232-9930
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-14
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI5885207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HICF072AMedicare PIN