Provider Demographics
NPI:1912940065
Name:HAWAII AIR AMBULANCE, INC
Entity Type:Organization
Organization Name:HAWAII AIR AMBULANCE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTS RECEIVABLE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:LONGENBAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-678-3222
Mailing Address - Street 1:PO BOX 68
Mailing Address - Street 2:
Mailing Address - City:BLANDING
Mailing Address - State:UT
Mailing Address - Zip Code:84511-0068
Mailing Address - Country:US
Mailing Address - Phone:435-678-3222
Mailing Address - Fax:
Practice Address - Street 1:155 KAPALULU PL
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-1806
Practice Address - Country:US
Practice Address - Phone:435-678-3222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416A0800XTransportation ServicesAmbulanceAir Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0404429601Medicaid
HI0000RCBBHMedicare ID - Type Unspecified