Provider Demographics
NPI:1083654032
Name:ISLAND ORTHOPEDIC SURGERY, INC.
Entity Type:Organization
Organization Name:ISLAND ORTHOPEDIC SURGERY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TETSUTO
Authorized Official - Middle Name:
Authorized Official - Last Name:NUMATA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-871-0778
Mailing Address - Street 1:PO BOX 1091
Mailing Address - Street 2:
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-1091
Mailing Address - Country:US
Mailing Address - Phone:808-871-0778
Mailing Address - Fax:808-442-0747
Practice Address - Street 1:140 HOOHANA ST
Practice Address - Street 2:SUITE 209
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-2467
Practice Address - Country:US
Practice Address - Phone:808-871-0778
Practice Address - Fax:808-442-0747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI57628Medicare ID - Type Unspecified