Big Island Family Medicine Inc
Organization Active NPI Family Medicine Physician · Hilo, HI
NPI 1124506845 · NPPES record last updated Aug 3, 2018
Key facts
- NPI
- 1124506845
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 13746 (HI)
- Legal business name
- BIG ISLAND FAMILY MEDICINE INC
- Practice address
- 670 Ponahawai St Ste 207
Hilo, HI 96720-7830 - Phone
- (808) 365-5988
- Fax
- (808) 365-5989
- NPI assigned
- Aug 3, 2018
- Organization subpart
- No
Authorized official
- Name
- Gina Salcedo, MD
- Title
- Owner
- Phone
- (808) 387-7970
Practitioners 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in HI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20181115001860 | HI | Part B Supplier - Clinic/Group Practice | 9830440395 |
Receives reassigned benefits from 1 practitioner Practice locations: Hilo, HI |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | 13746 | HI | Yes |
Addresses
Primary practice location
670 Ponahawai St Ste 207
Hilo, HI 96720-7830
Mailing address
670 Ponahawai St Ste 207
Hilo, HI 96720-7830
Phone (808) 365-5988
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00G0318159 | Other | HMSA (BSBS OF HAWAII) |
Other providers in Hilo, HI
- Shannon L Bianchi
- Jason Bianco
- Bickford Chiropractic LLC
- Paul Derrick Bickford
- Big Island Dentistry LLC
- Big Island Foot Care, Inc
- Big Island Health Clinic
- Big Island Hearing Center, LLC
- Big Island Massage Therapy LLC
- Big Island Optical, Inc
All providers in Hilo, HI · Family Medicine Physician in Hawaii
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 3, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.