Healthcare Provider Details

I. General information

NPI: 1780127225
Provider Name (Legal Business Name): LINDEN FAMILY MEDICINE CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2016
Last Update Date: 02/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 HUALANI ST STE 196
HILO HI
96720-4378
US

IV. Provider business mailing address

400 HUALANI ST STE 196
HILO HI
96720-4378
US

V. Phone/Fax

Practice location:
  • Phone: 808-961-0146
  • Fax: 808-969-3378
Mailing address:
  • Phone: 808-961-0146
  • Fax: 808-969-3378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MARGARET ROSEMARY LINDEN
Title or Position: MANAGER/OWNER
Credential:
Phone: 808-961-0146