| Organization Name: | STL MEDICAL SERVICES LLC |
| NPI Number: | 1306083175 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SEAN S GUPTON (CMO) |
| Mailing Address: | 305 Keawe St Suite 507 Lahaina |
| State: | HI US |
| Postal Code: | 967612734 |
| Phone Number: | 8086676161 |
| Fax Number: | 8086676166 |
| NPI Enumeration Date: | 01/15/2009 |
| NPI Last Update Date: | 01/15/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QU0200X |
| License Number: | MD-13784 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | HI |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Urgent Care |
| Taxonomy Definition: | |