12D2241343 CLIA NUMBER - WAIMEA PRIMARY CARE, LLC

Laboratory Demographics

CLIA Number: 12D2241343

Facility Name: WAIMEA PRIMARY CARE, LLC

Facility Address:
65-1298 KAWAIHAE ROAD, SUITE 3
KAMUELA, HI
ZIP 96743
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Facility Phone Number: 808 731-5003

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1417528399

Taxonomy: 363LP2300X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	12D2241343
LAB Type	Physician Office
Facility Name	WAIMEA PRIMARY CARE, LLC
Street	65-1298 KAWAIHAE ROAD, SUITE 3
City	KAMUELA
State	HI
ZIP	96743
Phone	808 731-5003
CertificateType	4
CertificateEffectiveDate	10/27/2023
CertificateExpirationDate	10/26/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024