Organization
KA WAI OLA MEDICAL CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEILANI KERR APRN (OWNER)
(808) 796-0168
Entity
Organization
Contact information
Practice address
16-590 OLD VOLCANO RD, STE. A, KEAAU, HI 96749-8158
(808) 796-0168
Mailing address
1695 AUWAE RD, HILO, HI 96720-6908
(808) 796-0168
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
APRN-1450
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A0324531
HMSA PROVIDER
HI
01
—
11105633
MEDICARE PTAN
HI
Enumeration date
09/14/2016
Last updated
09/14/2016
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