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35-2065 Old Mamalahoa Hwy Laupahoehoe HI 96764-9672 | |
(808) 747-6480 | |
(808) 775-9404 |
Full Name | |
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Speciality | Clinic/Center |
Location | 35-2065 Old Mamalahoa Hwy, Laupahoehoe, Hawaii |
Authorized Official Name and Position | Irene J Carpenter (CEO) |
Authorized Official Contact | 8087757204 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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45-549 Plumeria St Honokaa HI 96727-6902 Ph: (808) 775-7204 | 35-2065 Old Mamalahoa Hwy Laupahoehoe HI 96764-9672 Ph: (808) 747-6480 |
NPI Number | 1306347448 |
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Provider Enumeration Date | 02/23/2018 |
Last Update Date | 01/09/2023 |
Medicare PECOS PAC ID | 8325940885 |
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Medicare Enrollment ID | O20180522001888 |
Identifier | Type | State | Issuer |
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1306347448 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (Hawaii) | Primary |