=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578649588
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOUSECALLS OF HAWAII LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/31/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 75-6107 HOOMAMA ST
-----------------------------------------------------
City | KAILUA KONA
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96740-7953
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-987-3516
-----------------------------------------------------
Fax | 808-329-9082
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 4327
-----------------------------------------------------
City | KAILUA KONA
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96745-4327
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-987-3516
-----------------------------------------------------
Fax | 808-329-9082
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER PROVIDER
-----------------------------------------------------
Name | MR. DARREN STEVEN GELIGA
-----------------------------------------------------
Credential | PAC
-----------------------------------------------------
Telephone | 808-987-3516
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | AMD-191
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------