Provider Demographics
NPI:1760120315
Name:MCGILL HEALTHCARE LLC
Entity Type:Organization
Organization Name:MCGILL HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGILL
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:808-743-7473
Mailing Address - Street 1:5418 NAKOA ST
Mailing Address - Street 2:PO BOX 1436
Mailing Address - City:KOLOA
Mailing Address - State:HI
Mailing Address - Zip Code:96756
Mailing Address - Country:US
Mailing Address - Phone:808-743-7473
Mailing Address - Fax:
Practice Address - Street 1:5418 NAKOA ST
Practice Address - Street 2:
Practice Address - City:KOLOA
Practice Address - State:HI
Practice Address - Zip Code:96756
Practice Address - Country:US
Practice Address - Phone:808-743-7473
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-24
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3010790OtherKENTUCKY BON