Provider Demographics
NPI:1962446609
Name:PEARL CITY MEDICAL ASSOCIATES, INC.
Entity type:Organization
Organization Name:PEARL CITY MEDICAL ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIDGIT
Authorized Official - Middle Name:KL
Authorized Official - Last Name:ROVNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-488-1943
Mailing Address - Street 1:98-1079 MOANALUA ROAD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-4794
Mailing Address - Country:US
Mailing Address - Phone:808-488-0990
Mailing Address - Fax:808-486-4696
Practice Address - Street 1:98-1079 MOANALUA ROAD
Practice Address - Street 2:SUITE 500
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4794
Practice Address - Country:US
Practice Address - Phone:808-488-0990
Practice Address - Fax:808-486-4696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI50370701Medicaid
HIHPCMAMedicare ID - Type Unspecified