Provider Demographics
NPI:1164595229
Name:ALOHA FAMILY PRACTICE CLINIC, LLC
Entity Type:Organization
Organization Name:ALOHA FAMILY PRACTICE CLINIC, LLC
Other - Org Name:ALOHA CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:SCHUSSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-662-5642
Mailing Address - Street 1:180 DICKENSON ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LAHAINA
Mailing Address - State:HI
Mailing Address - Zip Code:96761-1215
Mailing Address - Country:US
Mailing Address - Phone:808-662-5642
Mailing Address - Fax:808-662-5642
Practice Address - Street 1:180 DICKENSON ST
Practice Address - Street 2:SUITE 103
Practice Address - City:LAHAINA
Practice Address - State:HI
Practice Address - Zip Code:96761-1215
Practice Address - Country:US
Practice Address - Phone:808-662-5642
Practice Address - Fax:808-662-5642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD6743261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI191746I1OtherSUMMERLIN
HI52799701Medicaid
HI191746I1OtherHMA
HIC063705OtherHMSA PIN
HI05530701Medicaid
HI062570275OtherALOHACARE
HI=========OtherHMAA
HIC063705OtherHMSA PIN
HIC063705OtherHMSA PIN
HIH55258Medicare ID - Type Unspecified