Provider Demographics
NPI:1073675245
Name:MAUI GASTROENTEROLOGY INC
Entity Type:Organization
Organization Name:MAUI GASTROENTEROLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:T
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACP
Authorized Official - Phone:808-877-5333
Mailing Address - Street 1:53 S PUUNENE AVE
Mailing Address - Street 2:SUITE 127
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96732-2121
Mailing Address - Country:US
Mailing Address - Phone:808-877-5333
Mailing Address - Fax:808-877-5335
Practice Address - Street 1:53 S PUUNENE AVE
Practice Address - Street 2:SUITE 127
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-2121
Practice Address - Country:US
Practice Address - Phone:808-877-5333
Practice Address - Fax:808-877-5335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD11540174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty