Provider Demographics
NPI:1922210871
Name:FAMILY CLINIC OF HAWAII, INC.
Entity Type:Organization
Organization Name:FAMILY CLINIC OF HAWAII, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EWA
Authorized Official - Middle Name:S
Authorized Official - Last Name:STAMPER
Authorized Official - Suffix:
Authorized Official - Credentials:PH D
Authorized Official - Phone:808-261-5555
Mailing Address - Street 1:30 AULIKE STREET
Mailing Address - Street 2:SUITE 308
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734
Mailing Address - Country:US
Mailing Address - Phone:808-261-5555
Mailing Address - Fax:808-261-5555
Practice Address - Street 1:30 AULIKE STREET
Practice Address - Street 2:SUITE 308
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734
Practice Address - Country:US
Practice Address - Phone:808-261-5555
Practice Address - Fax:808-261-5555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY525174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty