Basic Information
| Provider Information | |||||||||
| NPI: | 1871534735 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | STRAUB CLINIC & HOSPITAL | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | LANAI FAMILY HEALTH CENTER | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 631350 | ||||||||
| Address2: | |||||||||
| City: | LANAI CITY | ||||||||
| State: | HI | ||||||||
| PostalCode: | 96763 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 628 - B SEVENTH ST | ||||||||
| Address2: | |||||||||
| City: | LANAI CITY | ||||||||
| State: | HI | ||||||||
| PostalCode: | 96763 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8085656423 | ||||||||
| FaxNumber: | 8085657480 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2006 | ||||||||
| LastUpdateDate: | 10/31/2008 | ||||||||
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| AuthorizedOfficialLastName: | OTA | ||||||||
| AuthorizedOfficialFirstName: | JAMIE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CONTRACT MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8085357258 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332900000X | EOO813 | HI | Y | Suppliers | Non-Pharmacy Dispensing Site |
ID Information
| ID | Type | State | Issuer | Description | 1204433 | 01 | OTHER ID NUMBER-COMMERCIAL NUMBER | OTHER | 1204433 | 01 | OTHER ID NUMBER | OTHER |