Healthcare Provider Details

I. General information

NPI: 1598431348
Provider Name (Legal Business Name): CASTLE MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2021
Last Update Date: 08/20/2021
Certification Date: 08/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1245 KUALA ST
PEARL CITY HI
96782-3900
US

IV. Provider business mailing address

642 ULUKAHIKI ST
KAILUA HI
96734-4400
US

V. Phone/Fax

Practice location:
  • Phone: 808-456-2273
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DEREK A. DICKARD
Title or Position: DIRECTOR OF BUSINESS DEVELOPMENT
Credential:
Phone: 808-263-5011