Organization
NA PU UWAI
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JERRY J CLEMENTE (CHIEF FINANCIAL OFFICER)
(808) 560-3656
Entity
Organization
Contact information
Practice address
604 MAUNALOA HIGHWAY, BLDG. C, KAUNAKAKAI, HI 96748-0130
(808) 560-3653
(808) 560-3385
Mailing address
PO BOX 130, 604 MAUNALOA HIGHWAY, BLDG. C, KAUNAKAKAI, HI 96748-0130
(808) 560-3653
(808) 560-3385
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000243378
BCBS
—
05
—
54975103
—
HI
Enumeration date
08/31/2006
Last updated
08/16/2018
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