Provider Demographics
NPI:1316029259
Name:U.S. COAST GUARD ISC HONOLULU
Entity Type:Organization
Organization Name:U.S. COAST GUARD ISC HONOLULU
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:A
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-842-2927
Mailing Address - Street 1:400 SAND ISLAND PKWY
Mailing Address - Street 2:HEALTH SERVICES DIVISION
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819-4326
Mailing Address - Country:US
Mailing Address - Phone:808-842-2930
Mailing Address - Fax:808-842-2956
Practice Address - Street 1:400 SAND ISLAND PKWY
Practice Address - Street 2:HEALTH SERVICES DIVISION
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-4326
Practice Address - Country:US
Practice Address - Phone:808-842-2930
Practice Address - Fax:808-842-2956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1100XAmbulatory Health Care FacilitiesClinic/CenterMilitary/U.S. Coast Guard Outpatient