Provider Demographics
NPI:1649382508
Name:NA PU UWAI
Entity Type:Organization
Organization Name:NA PU UWAI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:CLEMENTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-560-3656
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:604 MAUNALOA HIGHWAY, BLDG. C
Mailing Address - City:KAUNAKAKAI
Mailing Address - State:HI
Mailing Address - Zip Code:96748-0130
Mailing Address - Country:US
Mailing Address - Phone:808-560-3653
Mailing Address - Fax:808-560-3385
Practice Address - Street 1:604 MAUNALOA HIGHWAY, BLDG. C
Practice Address - Street 2:
Practice Address - City:KAUNAKAKAI
Practice Address - State:HI
Practice Address - Zip Code:96748-0130
Practice Address - Country:US
Practice Address - Phone:808-560-3653
Practice Address - Fax:808-560-3385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI54975103Medicaid
0000243378OtherBCBS
HIH56538Medicare PIN