Provider Demographics
NPI:1316014756
Name:PACIFIC ISLAND MEDICAL, INC.
Entity Type:Organization
Organization Name:PACIFIC ISLAND MEDICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SCHUETTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-261-8885
Mailing Address - Street 1:156 HAMAKUA DR STE B
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-2834
Mailing Address - Country:US
Mailing Address - Phone:808-261-8885
Mailing Address - Fax:
Practice Address - Street 1:156 HAMAKUA DR
Practice Address - Street 2:STE.B
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2834
Practice Address - Country:US
Practice Address - Phone:808-261-8885
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI10510520332B00000X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI08370901Medicaid
HIA5085-4OtherHMSA
HI08370901Medicaid