MEDICARE: ISLAND URGENT CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1669817581
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ISLAND URGENT CARE LLC

Provider Business Mailing Address
First Line	:	6600 KALANIANAOLE HWY
Second Line	:	114A
City	:	HONOLULU
State	:	HI
Zip	:	96825-1273
Country	:	US
Telephone Number	:	808-395-2273
Fax Number	:	808-394-2273

Provider Business Practice Location Address
First Line	:	6600 KALANIANAOLE HWY
Second Line	:	114A
City	:	HONOLULU
State	:	HI
Zip	:	96825-1273
Country	:	US
Telephone Number	:	808-395-2273
Fax Number	:	808-394-2273

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ROBERT PAUL RUGGIERI
Credential	:	MD
Telephone Number	:	808-395-2273

Provider Enumeration Date	:	05/06/2013
Last Update Date	:	06/19/2013

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