Healthcare Provider Details

I. General information

NPI: 1720591209
Provider Name (Legal Business Name): HAWAII LIFE FLIGHT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2017
Last Update Date: 01/27/2022
Certification Date: 01/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1156 HIALOA ST
HILO HI
96720-3283
US

IV. Provider business mailing address

PO BOX 199
WEST PLAINS MO
65775-0199
US

V. Phone/Fax

Practice location:
  • Phone: 808-635-8264
  • Fax:
Mailing address:
  • Phone: 801-619-4900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416A0800X
TaxonomyAir Ambulance
License Number
License Number State

VIII. Authorized Official

Name: ERIC THOMAS
Title or Position: SVP OF REV MANAGEMENT
Credential:
Phone: 877-288-5340