Basic Information
| Provider Information | |||||||||
| NPI: | 1679823868 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HILO MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1190 WAIANUENUE AVE | ||||||||
| Address2: | |||||||||
| City: | HILO | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967202089 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8089323420 | ||||||||
| FaxNumber: | 8089746723 | ||||||||
| Practice Location | |||||||||
| Address1: | 1190 WAIANUENUE AVE | ||||||||
| Address2: | |||||||||
| City: | HILO | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967202089 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8089323420 | ||||||||
| FaxNumber: | 8089746723 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2012 | ||||||||
| LastUpdateDate: | 08/12/2022 | ||||||||
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| AuthorizedOfficialLastName: | YOUNG | ||||||||
| AuthorizedOfficialFirstName: | ESTRELITA | ||||||||
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| AuthorizedOfficialTitleorPosition: | REVENUE CYCLE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8089323420 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| NPICertificationDate: | 05/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 313M00000X | 44-N | HI | N | Nursing & Custodial Care Facilities | Nursing Facility/Intermediate Care Facility | 282N00000X | 34-H | HI | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 251745 | 05 | HI | MEDICAID |