Provider Demographics
NPI:1992131551
Name:COMPANION DX REFERENCE LAB- HAWAII, LLC
Entity type:Organization
Organization Name:COMPANION DX REFERENCE LAB- HAWAII, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXEC. VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:BLUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-538-1600
Mailing Address - Street 1:1236 LAUHALA ST
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2417
Mailing Address - Country:US
Mailing Address - Phone:808-691-4271
Mailing Address - Fax:808-691-4045
Practice Address - Street 1:1236 LAUHALA ST
Practice Address - Street 2:5TH FLOOR
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2417
Practice Address - Country:US
Practice Address - Phone:806-691-4271
Practice Address - Fax:806-691-4048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-16
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory