Healthcare Provider Details

I. General information

NPI: 1134499650
Provider Name (Legal Business Name): SURGICAL SPECIALTIES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2012
Last Update Date: 09/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1329 LUSITANA ST SUITE 401
HONOLULU HI
96813-2429
US

IV. Provider business mailing address

1329 LUSITANA ST SUITE 401
HONOLULU HI
96813-2429
US

V. Phone/Fax

Practice location:
  • Phone: 808-599-7779
  • Fax: 808-599-7780
Mailing address:
  • Phone: 808-599-7779
  • Fax: 808-599-7780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberFSOF22
License Number StateHI

VIII. Authorized Official

Name: DR. GARRY B PEERS
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 808-599-7779