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General NPI Number Information
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NPI Number | 1164865572
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Entity Type | Organization
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Legal Business Name | VIGILANT ANESTHETIX, PC
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Dates
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Enumeration Date | 04/16/2013
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Last Update Date | 04/16/2013
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Provider Practice Location Address
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Address Line | 1301 PUNCHBOWL STREET OPERATING ROOMS, 3RD FLOOR,
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City | HONOLULU
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State | HI
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Zip | 96813
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Country | US
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Telephone | 808-541-7888
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Fax |
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Provider Business Mailing Address
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Address Line | P O BOX 88169
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City | HONOLULU
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State | HI
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Zip | 96815-9998
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Country | US
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Telephone | 808-541-7888
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. BARUGUR SUBRAMANIAN RAVI
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Credential | MD
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Telephone | 808-541-7888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 15648
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License Number State | HI
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