Organization
SCOTT J. MISCOVICH MD, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RENE NOELLE MANSANAS (EXECUTIVE VICE PRESIDENT)
(808) 379-1515
Entity
Organization
Contact information
Practice address
46-001 KAMEHAMEHA HWY STE 109, KANEOHE, HI 96744-3724
(808) 247-7596
Mailing address
46-001 KAMEHAMEHA HWY STE 109, KANEOHE, HI 96744-3724
(808) 247-7596
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD6854
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05672605
—
HI
01
—
T065197
HMSA
HI
Enumeration date
12/14/2007
Last updated
09/06/2024
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