Provider Demographics
NPI:1770779274
Name:KIHEI CLINIC AND WAILEA MEDICAL SERVICES, LTD.
Entity type:Organization
Organization Name:KIHEI CLINIC AND WAILEA MEDICAL SERVICES, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELMER
Authorized Official - Middle Name:HARRY
Authorized Official - Last Name:RATZLAFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-879-1440
Mailing Address - Street 1:2349 S KIHEI RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-7202
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:808-879-7447
Practice Address - Street 1:2349 S KIHEI RD
Practice Address - Street 2:SUITE D
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-7202
Practice Address - Country:US
Practice Address - Phone:808-879-1440
Practice Address - Fax:808-879-7447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD7001261QF0050X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIE69393Medicare UPIN
HI0000BDRRMMedicare PIN