Provider Demographics
NPI:1245209162
Name:WINDWARD ORTHOPAEDIC GROUP INC
Entity Type:Organization
Organization Name:WINDWARD ORTHOPAEDIC GROUP INC
Other - Org Name:ROBERT L SIMMONS, MD, LTD, ETAL A HAWAII GENERAL PARTNERSHIP
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:M
Authorized Official - Last Name:PRIMACIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-203-6606
Mailing Address - Street 1:30 AULIKE ST STE 201
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-2750
Mailing Address - Country:US
Mailing Address - Phone:808-261-4658
Mailing Address - Fax:808-263-2036
Practice Address - Street 1:30 AULIKE ST
Practice Address - Street 2:SUITE 506
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2739
Practice Address - Country:US
Practice Address - Phone:808-261-4658
Practice Address - Fax:808-263-2036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI4390580001Medicare NSC