Ka Wai Ola Medical Clinic Llc | |
16-590 Old Volcano Rd Ste. A Keaau HI 96749-8158 | |
(808) 796-0168 | |
Not Available |
Full Name | Ka Wai Ola Medical Clinic Llc |
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Speciality | Clinic/Center |
Location | 16-590 Old Volcano Rd, Keaau, Hawaii |
Authorized Official Name and Position | Leilani Kerr (OWNER) |
Authorized Official Contact | 8087960168 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Ka Wai Ola Medical Clinic Llc 1695 Auwae Rd Hilo HI 96720-6908 Ph: (808) 796-0168 | Ka Wai Ola Medical Clinic Llc 16-590 Old Volcano Rd Ste. A Keaau HI 96749-8158 Ph: (808) 796-0168 |
NPI Number | 1487102877 |
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Provider Enumeration Date | 09/14/2016 |
Last Update Date | 09/14/2016 |
Medicare PECOS PAC ID | 3577841154 |
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Medicare Enrollment ID | O20161102001335 |
Identifier | Type | State | Issuer |
---|---|---|---|
1487102877 | NPI | - | NPPES |
11105633 | Other | HI | MEDICARE PTAN |
00A0324531 | Other | HI | HMSA PROVIDER |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QP2300X | Clinic/center - Primary Care | APRN-1450 (Hawaii) | Primary |
Provider Name | Leilani Cs Kerr |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1285982876 PECOS PAC ID: 4981836921 Enrollment ID: I20140407000816 |
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