Provider Demographics
NPI:1992975924
Name:MAUI NEPHROLOGY LLC
Entity type:Organization
Organization Name:MAUI NEPHROLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:WILBERT
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-276-3652
Mailing Address - Street 1:105 MAUILANI PKWY
Mailing Address - Street 2:STE.100
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-2442
Mailing Address - Country:US
Mailing Address - Phone:808-244-9555
Mailing Address - Fax:808-244-9577
Practice Address - Street 1:105 MAUILANI PKWY
Practice Address - Street 2:STE.100
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-2442
Practice Address - Country:US
Practice Address - Phone:808-244-9555
Practice Address - Fax:808-244-9577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD9767174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI49376801Medicaid
HI100848Medicare PIN
HI49376801Medicaid