Provider Demographics
NPI:1780737759
Name:IASIS SPINAL TREATMENT CENTER, LLC
Entity type:Organization
Organization Name:IASIS SPINAL TREATMENT CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:SEIYO
Authorized Official - Last Name:KAMIMURA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:808-542-4029
Mailing Address - Street 1:45-502 APIKI ST
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-1918
Mailing Address - Country:US
Mailing Address - Phone:808-542-4029
Mailing Address - Fax:808-739-2828
Practice Address - Street 1:4747 KILAUEA AVE
Practice Address - Street 2:#201
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-5308
Practice Address - Country:US
Practice Address - Phone:808-542-4029
Practice Address - Fax:808-739-2828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1497225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000257527OtherHMSA INSURANCE PROVIDER #