Provider Demographics
NPI:1316375900
Name:HAWAII PHYSICIANS ASSOCIATION LLC
Entity Type:Organization
Organization Name:HAWAII PHYSICIANS ASSOCIATION LLC
Other - Org Name:EAST HAWAII MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:A
Authorized Official - Last Name:MATSUURA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-969-3331
Mailing Address - Street 1:670 PONAHAWAI ST STE 214
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-7830
Mailing Address - Country:US
Mailing Address - Phone:808-969-3331
Mailing Address - Fax:808-935-6175
Practice Address - Street 1:80 PAUAHI ST STE 103
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-3043
Practice Address - Country:US
Practice Address - Phone:808-969-3331
Practice Address - Fax:808-935-6175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-17
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN-RX-445363LF0000X
HIAPRN-566363LF0000X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty