Healthcare Provider Details

I. General information

NPI: 1245386507
Provider Name (Legal Business Name): EBK HANDI -TRANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 07/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94-1021 KALOLI LOOP
WAIPAHU HI
96797-5410
US

IV. Provider business mailing address

94-1021 KALOLI LOOP
WAIPAHU HI
96797-5410
US

V. Phone/Fax

Practice location:
  • Phone: 808-688-2320
  • Fax: 808-688-2394
Mailing address:
  • Phone: 808-688-2320
  • Fax: 808-688-2394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License NumberW05184582
License Number StateHI

VIII. Authorized Official

Name: MR. EDMUND D. CALUCAG
Title or Position: PRESIDENT
Credential:
Phone: 808-688-2320