Provider Demographics
NPI:1215337563
Name:FIRST MEDICAL GROUP, INC.
Entity type:Organization
Organization Name:FIRST MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARCIANNE
Authorized Official - Middle Name:KUULEI
Authorized Official - Last Name:MONTOYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-692-6331
Mailing Address - Street 1:590 FARRINGTON HWY UNIT 507
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-2033
Mailing Address - Country:US
Mailing Address - Phone:808-692-6331
Mailing Address - Fax:808-674-9868
Practice Address - Street 1:590 FARRINGTON HWY UNIT 507
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-2033
Practice Address - Country:US
Practice Address - Phone:808-692-6331
Practice Address - Fax:808-674-9868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-22
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Single Specialty