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General NPI Number Information
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NPI Number | 1528042561
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Entity Type | Organization
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Legal Business Name | COMMUNITY CLINIC OF MAUI, INC.
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Dates
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Enumeration Date | 12/02/2005
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Last Update Date | 11/08/2024
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Provider Practice Location Address
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Address Line | 1881 NANI STREET
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City | WAILUKU
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State | HI
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Zip | 96793
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Country | US
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Telephone | 808-872-4006
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Fax | 808-495-0026
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Provider Business Mailing Address
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Address Line | 1881 NANI STREET
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City | WAILUKU
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State | HI
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Zip | 96793-1811
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Country | US
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Telephone | 808-871-7772
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Fax | 808-872-4029
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | JOHN VAZ
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Credential |
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Telephone | 808-872-4018
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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