Provider Demographics
NPI:1932252780
Name:RESORT MEDICAL SERVICES
Entity Type:Organization
Organization Name:RESORT MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:L
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-244-7627
Mailing Address - Street 1:30 N CHURCH ST
Mailing Address - Street 2:#100
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793
Mailing Address - Country:US
Mailing Address - Phone:808-244-7627
Mailing Address - Fax:808-243-2272
Practice Address - Street 1:3860 WAILEA ALANUI DR
Practice Address - Street 2:#102 B
Practice Address - City:WAULEA
Practice Address - State:HI
Practice Address - Zip Code:96793
Practice Address - Country:US
Practice Address - Phone:808-875-9095
Practice Address - Fax:808-875-9098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI3815207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI04550602Medicaid
HI04550602Medicaid
HI000DBDJLWMedicare ID - Type Unspecified