Provider Demographics
NPI:1417528399
Name:WAIMEA PRIMARY CARE LLC
Entity Type:Organization
Organization Name:WAIMEA PRIMARY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARLY
Authorized Official - Middle Name:KALEO
Authorized Official - Last Name:CORREA
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:808-756-0334
Mailing Address - Street 1:65-1298B KAWAIHAE RD STE 3
Mailing Address - Street 2:
Mailing Address - City:KAMUELA
Mailing Address - State:HI
Mailing Address - Zip Code:96743-7342
Mailing Address - Country:US
Mailing Address - Phone:808-756-0334
Mailing Address - Fax:808-731-4330
Practice Address - Street 1:65-1298B KAWAIHAE RD STE 3
Practice Address - Street 2:
Practice Address - City:KAMUELA
Practice Address - State:HI
Practice Address - Zip Code:96743-7342
Practice Address - Country:US
Practice Address - Phone:808-731-5003
Practice Address - Fax:808-731-4330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-01
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Multi-Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service