Basic Information
| Provider Information | |||||||||
| NPI: | 1316595556 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EAST HAWAII MEDICAL GROUP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1190 WAIANUENUE AVE | ||||||||
| Address2: | |||||||||
| City: | HILO | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967202089 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8089323428 | ||||||||
| FaxNumber: | 8089744746 | ||||||||
| Practice Location | |||||||||
| Address1: | 1190 WAIANUENUE AVE | ||||||||
| Address2: | |||||||||
| City: | HILO | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967202089 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8089323428 | ||||||||
| FaxNumber: | 8089744746 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2019 | ||||||||
| LastUpdateDate: | 08/30/2019 | ||||||||
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| AuthorizedOfficialLastName: | BRINKMAN | ||||||||
| AuthorizedOfficialFirstName: | DAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8089323101 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.