Healthcare Provider Details

I. General information

NPI: 1386929933
Provider Name (Legal Business Name): UH-HILO STUDENT MEDICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2011
Last Update Date: 10/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W KAWILI ST CAMPUS CENTER RM 212
HILO HI
96720-4075
US

IV. Provider business mailing address

200 W KAWILI ST CAMPUS CENTER RM 212
HILO HI
96720-4075
US

V. Phone/Fax

Practice location:
  • Phone: 808-974-7636
  • Fax: 808-933-0868
Mailing address:
  • Phone: 808-974-7636
  • Fax: 808-933-0868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberAPRN-RX
License Number StateHI

VIII. Authorized Official

Name: MRS. HEATHER HIRATA
Title or Position: DIRECTOR OF MEDICAL SERVICES
Credential: APRN-RX
Phone: 808-974-7636