Provider Demographics
NPI:1760652796
Name:JANE B SERVICE MD
Entity Type:Organization
Organization Name:JANE B SERVICE MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:B
Authorized Official - Last Name:SERVICE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-942-8411
Mailing Address - Street 1:PO BOX 25490
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96825-0490
Mailing Address - Country:US
Mailing Address - Phone:808-536-0300
Mailing Address - Fax:
Practice Address - Street 1:1319 PUNAHOU ST STE 510
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-1072
Practice Address - Country:US
Practice Address - Phone:808-952-8411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI4910207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty