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4643b Waimea Canyon Drive Waimea HI 96796-0487 | |
| (808) 240-0100 | |
| (808) 245-4146 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 4643b Waimea Canyon Drive, Waimea, Hawaii |
| Authorized Official Name and Position | David J Peters (CEO) |
| Authorized Official Contact | 8082400100 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 3990 Lihue HI 96766-6990 Ph: (808) 240-0100 | 4643b Waimea Canyon Drive Waimea HI 96796-0487 Ph: (808) 240-0100 |
| NPI Number | 1245269976 |
|---|---|
| Provider Enumeration Date | 07/03/2006 |
| Last Update Date | 07/21/2022 |
| Medicare PECOS PAC ID | 2860303021 |
|---|---|
| Medicare Enrollment ID | O20030912000005 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245269976 | NPI | - | NPPES |
| 523979 | Medicaid | HI | |
| 00D0230823 | Other | HI | HMSA FQHC 65C |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Hawaii Institute Of Innovation Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 65-1111a Church Rd, Waimea, HI 96743 Phone: 808-359-3326 | |
Hawaii Health Systems Corporation Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 4643 Waimea Canyon Dr, Ste B, Waimea, HI 96796 Phone: 808-338-8311 Fax: 808-338-0225 |