Provider Demographics
NPI:1265143259
Name:SKOPE ELMORE, BENJAMIN LUKE
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:LUKE
Last Name:SKOPE ELMORE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15-2817 OPAE ST
Mailing Address - Street 2:
Mailing Address - City:PAHOA
Mailing Address - State:HI
Mailing Address - Zip Code:96778-8605
Mailing Address - Country:US
Mailing Address - Phone:808-315-6908
Mailing Address - Fax:
Practice Address - Street 1:69 RAILROAD AVE STE A3
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-4574
Practice Address - Country:US
Practice Address - Phone:808-935-7949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-09
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician