Supernova Emergency Physicians, LLC

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

Legal business name

SUPERNOVA EMERGENCY PHYSICIANS, LLC

Practice address

221 Mahalani St
Wailuku, HI 96793-2526

Phone

(469) 401-2386

NPI assigned

Oct 9, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Tenna Behm

Title

Officer

Phone

(469) 401-2386

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1444348800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1444348800000",
    "number": "1003287566",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 98684",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891938684",
            "telephone_number": "469-401-2386"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "221 MAHALANI ST",
            "city": "WAILUKU",
            "state": "HI",
            "postal_code": "967932526",
            "telephone_number": "469-401-2386"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPERNOVA EMERGENCY PHYSICIANS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-09",
        "last_updated": "2015-10-09",
        "status": "A",
        "authorized_official_last_name": "BEHM",
        "authorized_official_first_name": "TENNA",
        "authorized_official_title_or_position": "OFFICER",
        "authorized_official_telephone_number": "469-401-2386"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Luke Stumfall
• Guy M. Sugino, MD
• Karise Sumabat
• Andrew Sumida
• Emilie Sumida, DDS
• Stephen Sussman, M.D.
• Robert Suzik, RN
• Jena Lei Suzuki, OTR/L OTD
• Susan M H Suzuki, SP
• Nicole Swallow, OTR/L

• Emergency Medicine Physician in Wailuku, HI
• Providers in Wailuku, HI by specialty
• Emergency Medicine Physician in Hawaii

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.