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General NPI Number Information
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NPI Number | 1285678953
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Entity Type | Individual
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Provider Name | THOMAS W EDHOLM M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/15/2006
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Last Update Date | 07/18/2016
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Provider Practice Location Address
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Address Line | KONA COMMUNITY HOSPTIAL 79-1019 HAUKAPILA STREET
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City | KEALAKEKUA
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State | HI
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Zip | 96750-7920
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Country | US
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Telephone | 808-547-9593
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Fax | 808-599-2714
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Provider Business Mailing Address
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Address Line | 2100 POWELL ST STE 900
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City | EMERYVILLE
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State | CA
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Zip | 94608-1844
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Country | US
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Telephone | 510-851-7423
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Fax | 510-879-9120
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207PE0004X
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Taxonomy Name | Emergency Medical Services (Emergency Medicine) Physician
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License Number | MD 13810
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License Number State | HI
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | G80869
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License Number State | CA
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