Healthcare Provider Details

I. General information

NPI: 1255683785
Provider Name (Legal Business Name): BIG ISLAND PAIN CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2012
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 ULULANI ST
HILO HI
96720-2933
US

IV. Provider business mailing address

8 CHERRY HILLS DR
ENGLEWOOD CO
80113-4812
US

V. Phone/Fax

Practice location:
  • Phone: 808-934-9675
  • Fax:
Mailing address:
  • Phone: 808-934-9675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License NumberW5908947001
License Number StateHI
# 3
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License NumberW5908947001
License Number StateHI
# 4
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LYNN PUANA
Title or Position: EXECUTIVE OFFICER
Credential: MD
Phone: 808-934-9675