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General NPI Number Information
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NPI Number | 1164595229
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Entity Type | Organization
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Legal Business Name | ALOHA FAMILY PRACTICE CLINIC, LLC
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Dates
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Enumeration Date | 11/16/2006
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Last Update Date | 04/20/2015
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Provider Practice Location Address
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Address Line | 180 DICKENSON ST SUITE 103
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City | LAHAINA
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State | HI
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Zip | 96761-1215
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Country | US
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Telephone | 808-662-5642
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Fax | 808-662-5642
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Provider Business Mailing Address
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Address Line | 180 DICKENSON ST SUITE 103
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City | LAHAINA
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State | HI
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Zip | 96761-1215
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Country | US
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Telephone | 808-662-5642
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Fax | 808-662-5642
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | MR. DOUGLAS JOHN SCHUSSER
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Credential |
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Telephone | 808-662-5642
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | MD6743
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License Number State | HI
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