Provider Demographics
NPI:1720329923
Name:MINUTECLINIC DIAGNOSTIC OF HAWAII, L.L.C.
Entity Type:Organization
Organization Name:MINUTECLINIC DIAGNOSTIC OF HAWAII, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:PINCINCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-770-3813
Mailing Address - Street 1:1 CVS DR
Mailing Address - Street 2:MC 2295
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895-6146
Mailing Address - Country:US
Mailing Address - Phone:401-770-3813
Mailing Address - Fax:770-216-3549
Practice Address - Street 1:45-480 KANEOHE BAY DR
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744
Practice Address - Country:US
Practice Address - Phone:866-389-2727
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MINUTECLINIC DIAGNOSTIC OF HAWAII, L.L.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-03-13
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIH104069Medicare PIN