Provider Demographics
NPI:1083071922
Name:US MED URGENT CARE, LLC
Entity Type:Organization
Organization Name:US MED URGENT CARE, LLC
Other - Org Name:US MED KAILUA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-465-2273
Mailing Address - Street 1:1245 KUALA ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PEARL CITY
Mailing Address - State:HI
Mailing Address - Zip Code:96782-3900
Mailing Address - Country:US
Mailing Address - Phone:808-456-2273
Mailing Address - Fax:808-456-2274
Practice Address - Street 1:660 KAILUA RD
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2809
Practice Address - Country:US
Practice Address - Phone:808-263-2273
Practice Address - Fax:808-263-2274
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:US MED URGENT CARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-01-22
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIFR689AMedicare PIN