1801253745 NPI number — US MED URGENT CARE, LLC

Table of content: (NPI 1801253745)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801253745 NPI number — US MED URGENT CARE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
US MED URGENT CARE, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
US MED WAIKIKI
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801253745
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/21/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1245 KUALA ST
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
PEARL CITY
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96782-3900
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-456-2273
Provider Business Mailing Address Fax Number:
808-456-2274

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1860 ALA MOANA BLVD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96815-1632
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-921-2273
Provider Business Practice Location Address Fax Number:
808-921-2274
Provider Enumeration Date:
01/22/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SCHMIDT
Authorized Official First Name:
DONNA
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
808-465-2273

Provider Taxonomy Codes

  • Taxonomy code: 261QU0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)