Basic Information
| Provider Information | |||||||||
| NPI: | 1083071922 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | US MED URGENT CARE, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | US MED KAILUA | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1245 KUALA ST | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | PEARL CITY | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967823900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8084562273 | ||||||||
| FaxNumber: | 8084562274 | ||||||||
| Practice Location | |||||||||
| Address1: | 660 KAILUA RD | ||||||||
| Address2: | |||||||||
| City: | KAILUA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967342809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8082632273 | ||||||||
| FaxNumber: | 8082632274 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2016 | ||||||||
| LastUpdateDate: | 10/25/2016 | ||||||||
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| AuthorizedOfficialLastName: | SCHMIDT | ||||||||
| AuthorizedOfficialFirstName: | DONNA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 8084652273 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | US MED URGENT CARE, LLC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
No ID Information.