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68-1845 Waikoloa Road Suite 207 Waikoloa HI 96738-5581 | |
(808) 326-3883 | |
(808) 329-9370 |
Full Name | |
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Speciality | Clinic/Center |
Location | 68-1845 Waikoloa Road, Waikoloa, Hawaii |
Authorized Official Name and Position | Richard J Taaffe (CEO) |
Authorized Official Contact | 8083263883 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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75-5751 Kuakini Hwy Suite 203 Kailua Kona HI 96740-1753 Ph: (808) 326-3883 | 68-1845 Waikoloa Road Suite 207 Waikoloa HI 96738-5581 Ph: (808) 326-3883 |
NPI Number | 1649520644 |
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Provider Enumeration Date | 09/17/2012 |
Last Update Date | 01/04/2013 |
Medicare PECOS PAC ID | 1557389400 |
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Medicare Enrollment ID | O20130615000080 |
Identifier | Type | State | Issuer |
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1649520644 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |