Provider Demographics
NPI:1639102320
Name:PACIFIC MEDICINE, LLP
Entity Type:Organization
Organization Name:PACIFIC MEDICINE, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOYCELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:JUREK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-524-2100
Mailing Address - Street 1:1329 LUSITANA ST
Mailing Address - Street 2:SUITE 704
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2429
Mailing Address - Country:US
Mailing Address - Phone:808-524-2100
Mailing Address - Fax:808-534-0593
Practice Address - Street 1:1329 LUSITANA ST
Practice Address - Street 2:SUITE 704
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2429
Practice Address - Country:US
Practice Address - Phone:808-524-2100
Practice Address - Fax:808-534-0593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI55234Medicare UPIN