Healthcare Provider Details

I. General information

NPI: 1760120315
Provider Name (Legal Business Name): MCGILL HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2022
Last Update Date: 07/24/2024
Certification Date: 07/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5418 NAKOA ST
KOLOA HI
96756
US

IV. Provider business mailing address

5418 NAKOA ST PO BOX 1436
KOLOA HI
96756
US

V. Phone/Fax

Practice location:
  • Phone: 808-743-7473
  • Fax:
Mailing address:
  • Phone: 808-742-9140
  • Fax: 808-207-3805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. DENNIS MCGILL
Title or Position: PRESIDENT
Credential: APRN
Phone: 808-743-7473