Provider Demographics
NPI:1528227816
Name:NORTH KONA URGENT CARE CENTER
Entity Type:Organization
Organization Name:NORTH KONA URGENT CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ILEANA
Authorized Official - Middle Name:C
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-322-2544
Mailing Address - Street 1:73-5618 MAIAU ST
Mailing Address - Street 2:STE B106
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-2634
Mailing Address - Country:US
Mailing Address - Phone:808-331-8390
Mailing Address - Fax:808-331-8139
Practice Address - Street 1:78 6831 ALII DR
Practice Address - Street 2:STE K9
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740
Practice Address - Country:US
Practice Address - Phone:808-322-2544
Practice Address - Fax:808-322-0154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-03
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI100361Medicare PIN