Provider Demographics
NPI:1346784139
Name:EAST MAUI MEDICAL CLINIC, LLP
Entity Type:Organization
Organization Name:EAST MAUI MEDICAL CLINIC, LLP
Other - Org Name:PUEO FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:CURTIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BEKKUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-856-1735
Mailing Address - Street 1:PO BOX 278
Mailing Address - Street 2:
Mailing Address - City:HANA
Mailing Address - State:HI
Mailing Address - Zip Code:96713-0278
Mailing Address - Country:US
Mailing Address - Phone:808-248-8840
Mailing Address - Fax:808-248-8839
Practice Address - Street 1:4950 UAKEA ROAD
Practice Address - Street 2:UNIT 2
Practice Address - City:HANA
Practice Address - State:HI
Practice Address - Zip Code:96713-0278
Practice Address - Country:US
Practice Address - Phone:808-248-8840
Practice Address - Fax:808-248-8839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD17180261QP2300X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
1699899500OtherNPI