Basic Information
| Provider Information | |||||||||
| NPI: | 1588753453 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FAMILY MEDICINE CLINIC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 JARRETT WHITE RD | ||||||||
| Address2: | TRIPLER ARMY MEDICAL CENTER ATTN: MCHK-QS | ||||||||
| City: | TAMC | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968595001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8084332460 | ||||||||
| FaxNumber: | 8084331558 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 JARRETT WHITE RD | ||||||||
| Address2: | TRIPLER ARMY MEDICAL CENTER ATTN: MCHK-QS | ||||||||
| City: | TAMC | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968595001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8084332460 | ||||||||
| FaxNumber: | 8084331558 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2006 | ||||||||
| LastUpdateDate: | 08/12/2008 | ||||||||
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| AuthorizedOfficialLastName: | PIOTROWSKI | ||||||||
| AuthorizedOfficialFirstName: | ANASTASIA | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | RESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8084333300 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 286500000X | MD-13982 | HI | Y | Hospitals | Military Hospital |
No ID Information.