Organization Active NPI

Tide Osteopathy, LLC

  • Clinic/Center
  • Kailua, HI
National Provider Identifier
1679294250
Registry record updated Sep 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
TIDE OSTEOPATHY, LLC
Practice address
320 Uluniu St Ste 2
Kailua, HI 96734-2529
Phone
(808) 721-5410
NPI assigned
Sep 12, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Love Volkova, DONPI 1194011403
Title
Physician
Phone
(808) 721-2629

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

320 Uluniu St Ste 2
Kailua, HI 96734-2529

Mailing address

111 Hekili St Ste A504
Kailua, HI 96734-2800
Phone (808) 721-2629

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in HI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20221212003048 HI Part B Supplier - Clinic/Group Practice 6103295290 Receives reassigned benefits from 1 practitioner
Practice locations: Kailua, HI

National Provider Directory

National Provider Directory

Locations

111 Hekili St
Ste A504
Kailua, HI 96734

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1662940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1662940800000",
    "number": "1679294250",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 HEKILI ST STE A504",
            "city": "KAILUA",
            "state": "HI",
            "postal_code": "967342800",
            "telephone_number": "808-721-2629"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 ULUNIU ST STE 2",
            "city": "KAILUA",
            "state": "HI",
            "postal_code": "967342529",
            "telephone_number": "808-721-5410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIDE OSTEOPATHY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-12",
        "last_updated": "2022-09-12",
        "certification_date": "2022-09-11",
        "status": "A",
        "authorized_official_last_name": "VOLKOVA",
        "authorized_official_first_name": "LOVE",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "808-721-2629",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kailua, HI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.