Provider Demographics
NPI:1073138822
Name:OHANA MED GROUP, LLC
Entity Type:Organization
Organization Name:OHANA MED GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:CALK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-735-1736
Mailing Address - Street 1:PO BOX 321
Mailing Address - Street 2:
Mailing Address - City:MONTAGUE
Mailing Address - State:TX
Mailing Address - Zip Code:76251-0321
Mailing Address - Country:US
Mailing Address - Phone:940-735-1736
Mailing Address - Fax:940-427-7189
Practice Address - Street 1:398 ALAMO RD
Practice Address - Street 2:
Practice Address - City:MONTAGUE
Practice Address - State:TX
Practice Address - Zip Code:76251-1120
Practice Address - Country:US
Practice Address - Phone:940-735-1736
Practice Address - Fax:940-427-7189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-08
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies