Provider Demographics
NPI:1629338165
Name:ACUTE CARE CLINIC, INC.
Entity Type:Organization
Organization Name:ACUTE CARE CLINIC, INC.
Other - Org Name:KEAUHOU-KONA MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAMBERT
Authorized Official - Middle Name:K
Authorized Official - Last Name:LEE LOY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-322-2750
Mailing Address - Street 1:PO BOX 390932
Mailing Address - Street 2:
Mailing Address - City:KEAUHOU
Mailing Address - State:HI
Mailing Address - Zip Code:96739-0932
Mailing Address - Country:US
Mailing Address - Phone:808-322-2750
Mailing Address - Fax:808-322-2995
Practice Address - Street 1:78-6831 ALII DR STE 169
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-4409
Practice Address - Country:US
Practice Address - Phone:808-322-2750
Practice Address - Fax:808-322-2995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-17
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD4705208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI013254 01Medicaid
HIH0000BDNZTMedicare PIN
HIC97475Medicare UPIN