12D2209641 CLIA NUMBER - MAKANA NORTH SHORE CLINIC

Laboratory Demographics

  • CLIA Code: 12D2209641
  • Facility Name: MAKANA NORTH SHORE CLINIC
  • Facility Address: 4488 HANALEI PLANTATION ROAD
    PRINCEVILLE, HI
    ZIP 96722
  • Facility Phone: 808 320-7300
  • Facility Type: Rural Health Clinic
  • Facility Type: Waiver
  • Lab Director: EDWARD J. KIMBALL
  • NPI Number: 1114431632
  • Taxonomy: 261QU0200X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 12D2209641
LAB Type Rural Health Clinic
Facility Name MAKANA NORTH SHORE CLINIC
Street 4488 HANALEI PLANTATION ROAD
City PRINCEVILLE
State HI
ZIP 96722
Phone 808 320-7300
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/14/2025
Certificate Expiration Date 1/13/2027
Facility Type Rural Health Clinic
Lab Director EDWARD J. KIMBALL

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This page was last updated on: 9/29/2025