Provider Demographics
NPI:1386929933
Name:UH-HILO STUDENT MEDICAL SERVICES
Entity type:Organization
Organization Name:UH-HILO STUDENT MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF MEDICAL SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:HIRATA
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-RX
Authorized Official - Phone:808-974-7636
Mailing Address - Street 1:200 W KAWILI ST
Mailing Address - Street 2:CAMPUS CENTER RM 212
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-4075
Mailing Address - Country:US
Mailing Address - Phone:808-974-7636
Mailing Address - Fax:808-933-0868
Practice Address - Street 1:200 W KAWILI ST
Practice Address - Street 2:CAMPUS CENTER RM 212
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-4075
Practice Address - Country:US
Practice Address - Phone:808-974-7636
Practice Address - Fax:808-933-0868
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF HAWAII @ HILO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-10-14
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN-RX261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI1801982749OtherNPI
HI1316180714OtherNPI