Provider Demographics
NPI:1316675630
Name:ISLAND MEDICAL CARE INC
Entity type:Organization
Organization Name:ISLAND MEDICAL CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:ISADORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-594-7845
Mailing Address - Street 1:647 KUNAWAI LN APT 408
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-2259
Mailing Address - Country:US
Mailing Address - Phone:808-594-7845
Mailing Address - Fax:
Practice Address - Street 1:410 KILANI AVE
Practice Address - Street 2:
Practice Address - City:WAHIAWA
Practice Address - State:HI
Practice Address - Zip Code:96786-1844
Practice Address - Country:US
Practice Address - Phone:808-594-7845
Practice Address - Fax:844-285-8853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-14
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI088472Medicaid