| Glenn Family Medicine, Llc | |
|
85 Maui Lani Pkwy Wailuku HI 96793-2416 | |
| (330) 904-9354 | |
| Not Available |
| Full Name | Glenn Family Medicine, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 85 Maui Lani Pkwy, Wailuku, Hawaii |
| Authorized Official Name and Position | Travis Wagner Glenn (MEMBER) |
| Authorized Official Contact | 8082445366 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Glenn Family Medicine, Llc 85 Maui Lani Pkwy Wailuku HI 96793-2416 Ph: (808) 244-5366 | Glenn Family Medicine, Llc 85 Maui Lani Pkwy Wailuku HI 96793-2416 Ph: (330) 904-9354 |
| NPI Number | 1508443805 |
|---|---|
| Provider Enumeration Date | 03/24/2021 |
| Last Update Date | 12/09/2022 |
| Medicare PECOS PAC ID | 8729480744 |
|---|---|
| Medicare Enrollment ID | O20210714001118 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508443805 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Travis Wagner Glenn |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1841729670 PECOS PAC ID: 3274866207 Enrollment ID: I20210730001065 |
| Provider Name | Bradley Holman Glenn |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1043749872 PECOS PAC ID: 7911230016 Enrollment ID: I20210730001261 |
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