Provider Demographics
NPI:1073558417
Name:KAHALA URGENT CARE INC.
Entity Type:Organization
Organization Name:KAHALA URGENT CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:P
Authorized Official - Last Name:RUGGIERI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-735-0007
Mailing Address - Street 1:4218 WAIALAE AVE
Mailing Address - Street 2:A106
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-5321
Mailing Address - Country:US
Mailing Address - Phone:808-735-0007
Mailing Address - Fax:808-735-0021
Practice Address - Street 1:4218 WAIALAE AVE
Practice Address - Street 2:106A
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-5321
Practice Address - Country:US
Practice Address - Phone:808-735-0007
Practice Address - Fax:808-735-0021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2011-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI101795Medicare PIN