Provider Demographics
NPI:1215124656
Name:RESORT MEDICINE LLC
Entity type:Organization
Organization Name:RESORT MEDICINE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:D
Authorized Official - Last Name:BIRD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-891-1111
Mailing Address - Street 1:3860 WAILEA ALANUI DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WAILEA
Mailing Address - State:HI
Mailing Address - Zip Code:96753-8447
Mailing Address - Country:US
Mailing Address - Phone:808-891-1111
Mailing Address - Fax:808-891-1123
Practice Address - Street 1:3860 WAILEA ALANUI DR
Practice Address - Street 2:SUITE 102
Practice Address - City:WAILEA
Practice Address - State:HI
Practice Address - Zip Code:96753-8447
Practice Address - Country:US
Practice Address - Phone:808-891-1111
Practice Address - Fax:808-891-1123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIW27220253-01261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care