Provider Demographics
NPI:1629183801
Name:MID PACIFIC ENT INSTITUTE INC
Entity Type:Organization
Organization Name:MID PACIFIC ENT INSTITUTE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCLAUGHLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:808-533-0400
Mailing Address - Street 1:405 N KUAKINI ST
Mailing Address - Street 2:#902
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-6302
Mailing Address - Country:US
Mailing Address - Phone:808-533-0400
Mailing Address - Fax:808-533-0401
Practice Address - Street 1:405 N KUAKINI ST
Practice Address - Street 2:#902
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-6302
Practice Address - Country:US
Practice Address - Phone:808-533-0400
Practice Address - Fax:808-533-0401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HID05912207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI554502Medicaid
H39609Medicare UPIN
HIH54592Medicare ID - Type Unspecified