Provider Demographics
NPI:1689013534
Name:SPECIALTY SURGICAL SUITES, LLC
Entity Type:Organization
Organization Name:SPECIALTY SURGICAL SUITES, LLC
Other - Org Name:MINIMALLY INVASIVE SURGERY OF HAWAII
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:T
Authorized Official - Last Name:BLUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-536-2261
Mailing Address - Street 1:1401 S BERETANIA ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-1870
Mailing Address - Country:US
Mailing Address - Phone:808-536-2261
Mailing Address - Fax:808-538-3957
Practice Address - Street 1:1401 S BERETANIA ST
Practice Address - Street 2:SUITE 600
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-1870
Practice Address - Country:US
Practice Address - Phone:808-536-2261
Practice Address - Fax:808-538-3957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-24
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical