Provider Demographics
NPI:1104956325
Name:COAST GUARD
Entity type:Organization
Organization Name:COAST GUARD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HELTH SCVS TECHNICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ZACHARY
Authorized Official - Middle Name:FLOYD
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:HS3
Authorized Official - Phone:808-433-9794
Mailing Address - Street 1:1629 FUNSTON LOOP APT E
Mailing Address - Street 2:1 JARRETT WHITE ROAD
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819-2159
Mailing Address - Country:US
Mailing Address - Phone:808-224-7351
Mailing Address - Fax:808-433-9796
Practice Address - Street 1:1 JARRETT WHITE RD
Practice Address - Street 2:
Practice Address - City:TAMC
Practice Address - State:HI
Practice Address - Zip Code:96859-5001
Practice Address - Country:US
Practice Address - Phone:808-433-9794
Practice Address - Fax:808-433-9796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service