Provider Demographics
NPI:1821467796
Name:POIPU MD, LLC
Entity Type:Organization
Organization Name:POIPU MD, LLC
Other - Org Name:POIPU MOBILE MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:J
Authorized Official - Middle Name:
Authorized Official - Last Name:BURRIS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD, MPH
Authorized Official - Phone:808-652-7021
Mailing Address - Street 1:PO BOX 1652
Mailing Address - Street 2:
Mailing Address - City:KOLOA
Mailing Address - State:HI
Mailing Address - Zip Code:96756-1652
Mailing Address - Country:US
Mailing Address - Phone:808-346-3324
Mailing Address - Fax:
Practice Address - Street 1:5485 KOLOA RD
Practice Address - Street 2:SUITE 1652
Practice Address - City:KOLOA
Practice Address - State:HI
Practice Address - Zip Code:96756-3001
Practice Address - Country:US
Practice Address - Phone:808-346-3324
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:POIPU MD, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-09-21
Last Update Date:2016-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI14727261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care