NPI 1275798928

Market Street Clinic, INC.

Organisation Health Maintenance Organization Wailuku, HI

Practice location

Address: 53a N Market St, Wailuku, HI 96793-1719
Phone: (808) 244-0007
Fax: (808) 244-8011

Authorised official

Name: Chris Alan Boulange
Title: President/General Practitioner
Phone: (808) 244-0007

Registered specialties

Health Maintenance Organization Primary

Managed Care Organizations Taxonomy 302R00000X Licence MD-2877 (HI)

Other Health Maintenance Organization providers in Hawaii →

Registry record

NPI: 1275798928
Entity type: Organization
NPI issued: 22 Jul 2008
Record last updated: 22 Jul 2008

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.