Provider Demographics
NPI:1144373754
Name:SAMBELLE TRANSPORT LLC
Entity type:Organization
Organization Name:SAMBELLE TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-341-2443
Mailing Address - Street 1:98-1472 HOOHONUA ST
Mailing Address - Street 2:
Mailing Address - City:PEARL CITY
Mailing Address - State:HI
Mailing Address - Zip Code:96782-2315
Mailing Address - Country:US
Mailing Address - Phone:808-341-2443
Mailing Address - Fax:808-454-2402
Practice Address - Street 1:98-1472 HOOHONUA ST
Practice Address - Street 2:
Practice Address - City:PEARL CITY
Practice Address - State:HI
Practice Address - Zip Code:96782-2315
Practice Address - Country:US
Practice Address - Phone:808-341-2443
Practice Address - Fax:808-454-2402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPUC1851-C343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI57614201Medicaid