Organization
MARKET STREET CLINIC, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHRIS ALAN BOULANGE M.D. (PRESIDENT/GENERAL PRACTITIONER)
(808) 244-0007
Entity
Organization
Contact information
Practice address
53A N MARKET ST, WAILUKU, HI 96793-1719
(808) 244-0007
(808) 244-8011
Mailing address
53A N MARKET ST, WAILUKU, HI 96793-1719
(808) 244-0007
(808) 244-8011
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
MD-2877
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08781201
—
HI
01
—
A21446-8
HMSA
HI
Enumeration date
07/22/2008
Last updated
07/22/2008
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