KOA COMMUNITY CLINIC, INC (NPI# 1952920555) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1952920555 |
| Entity Type | Organization |
| Organization Name | KOA COMMUNITY CLINIC, INC |
| Practice Address |
75-5995 Kuakini Hwy Ste 445 Kailua Kona HI 96740-2123 |
| Practice Telephone | 8086383343 |
| Practice Fax Number | 8443083545 |
| Mailing Telephone | 8086383343 |
| Mailing Fax Number | 8443083545 |
| Enumeration Date | 2020-04-13 |
| Last Update Date | 2020-04-13 |
| Authorized Official Name | DR. CORINNE MAUL DE SOTO (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 8086383343 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QR1300X |
Clinic/Center Specialization: Rural Health |
Ambulatory Health Care Facilities | ||
| Y | 261QC1500X |
Clinic/Center Specialization: Community Health |
Ambulatory Health Care Facilities |
| Street Address |
75-5995 KUAKINI HWY STE 445 |
| City | KAILUA KONA |
| State | HI |
| Zip Code | 96740-2123 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750836193 | Deborah Vance Beaumont | Clinical Nurse Specialist | 75-5995 Kuakini Hwy Ste 445, Kailua Kona, HI 96740-2123 | 2016-08-15 |
| 1528576436 | Koa Clinic, Inc | Clinic/Center | 75-5995 Kuakini Hwy Ste 445, Kailua Kona, HI 96740-2123 | 2018-01-12 |
| 1164950150 | Erin Lea Heidrich | Acupuncturist | 75-5995 Kuakini Hwy Ste 445, Kailua Kona, HI 96740-2123 | 2017-06-02 |
| 1639620222 | Mind Body Nutrition Rn | Clinical Nurse Specialist | 75-5995 Kuakini Hwy Ste 445, Kailua Kona, HI 96740-2123 | 2016-10-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649870577 | Elise Christine Duvua | Massage Therapist | 75-127 Lunadule Rd. Suite #5, Kailua Kona, HI 96740 | 2020-10-29 |
| 1356954820 | Zellda Keath | Acupuncturist | Kohanaiki Club Services, 73-2055 Ala Kohanaiki, Kailua-kona, HI 96740 | 2020-08-25 |
| 1467070979 | Safeway Inc | Durable Medical Equipment & Medical Supplies | 75-971 Henry St, Kailua Kona, HI 96740 | 2020-07-10 |
| 1275182040 | Jessica Marie Penaranda | Pharmacist | 5595 Palani Road, Kona, HI 96740 | 2019-09-05 |
| 1558870600 | Malia Lewis Vannatta | Nurse Practitioner | 75-184 Hulalalai Rd, 302, Kailua Kona, HI 96740 | 2017-09-20 |
| 1043759087 | Paul Michael Heller | Acupuncturist | 72 3996 Hawaii Belt Rd, Kailua Kona, HI 96740 | 2017-02-22 |
| 1255787974 | John Fujita | Pharmacist | 74-5456 Kamakaeha Ave, Kailua Kona, HI 96740 | 2016-05-11 |
| 1326425083 | Lauren Deweese | Massage Therapist | 76-6194 Holualoa Beach Rd, Unit 6, Kailua-kona, HI 96740 | 2015-05-01 |
| 1073907754 | Kathleen Marie Coyle | Massage Therapist | 76-217 Keakealani Street, Kailua Kona, HI 96740 | 2015-03-20 |
| 1841609971 | Shellie R Norman | Nurse Practitioner | 75-5995 Kuakini Hwy Ste 443&445, Kailua Kona, HI 96740 | 2014-08-01 |
| Find all providers in zip 96740 | ||||
| Taxonomy Code | 261QC1500X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Community Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891301016 | Maika'i Health Corporation | Clinic/Center | 670 Ponahawai St Ste 206, Hilo, HI 96720-7830 | 2020-09-22 |
| 1225281793 | Community Clinic of Maui, Inc. | Clinic/Center | 670 Waiale Rd, Wailuku, HI 96793 | 2008-10-28 |
| 1053564526 | Community Clinic of Maui Inc | Clinic/Center | 15 Ipu Aumakua Ln, Lahaina, HI 96761 | 2008-10-28 |
| 1316317100 | Lanai Community Health Center | Clinic/Center | 333 Sixth Street, Lanai City, HI 96763-0142 | 2015-10-06 |
| 1801020623 | Barbara Ann Kualii | Clinic/Center | 224 Haili St, Bldg B, Hilo, HI 96720-2975 | 2009-05-07 |
| 1659531622 | Kauai Community Health Alliance | Clinic/Center | 2460 Oka St, 101-a, Kilauea, HI 96754-5308 | 2008-06-13 |
| 1457548596 | David G Seriguchi, Md Inc | Clinic/Center | 1931 E Vineyard St, Suite 102, Wailuku, HI 96793-1700 | 2007-10-03 |
| 1780738005 | Waimanalo Health Center | Clinic/Center | 41-1347 Kalanianaole Hwy, Waimanalo, HI 96795-1247 | 2007-01-23 |
| City | KAILUA KONA |
| Zip Code | 96740 |
Please comment or provide details below to improve the information on KOA COMMUNITY CLINIC, INC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.