1346784139 NPI number — EAST MAUI MEDICAL CLINIC, LLP

Table of content: (NPI 1346784139)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346784139 NPI number — EAST MAUI MEDICAL CLINIC, LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EAST MAUI MEDICAL CLINIC, LLP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346784139
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 278
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HANA
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96713-0278
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-248-8840
Provider Business Mailing Address Fax Number:
808-248-8839

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4950 UAKEA ROAD
Provider Second Line Business Practice Location Address:
UNIT 2
Provider Business Practice Location Address City Name:
HANA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96713-0278
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-248-8840
Provider Business Practice Location Address Fax Number:
808-248-8839
Provider Enumeration Date:
12/13/2016

Additional Information

Authorized Official

Authorized Official Last Name:
BEKKUM
Authorized Official First Name:
CURTIS
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/PROVIDER
Authorized Official Telephone Number:
808-856-1735

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  MD17180 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1699899500 . This is a "NPI" identifier . This identifiers is of the category "OTHER".




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