Healthcare Provider Details

I. General information

NPI: 1679823868
Provider Name (Legal Business Name): HILO MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2012
Last Update Date: 08/12/2022
Certification Date: 05/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1190 WAIANUENUE AVE
HILO HI
96720-2089
US

IV. Provider business mailing address

1190 WAIANUENUE AVE
HILO HI
96720-2089
US

V. Phone/Fax

Practice location:
  • Phone: 808-932-3420
  • Fax: 808-974-6723
Mailing address:
  • Phone: 808-932-3420
  • Fax: 808-974-6723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number34-H
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number44-N
License Number StateHI

VIII. Authorized Official

Name: MS. ESTRELITA YOUNG
Title or Position: REVENUE CYCLE MANAGER
Credential:
Phone: 808-932-3420