Basic Information
| Provider Information | |||||||||
| NPI: | 1346277621 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HILO MEDICAL CENTER ANESTHESIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 233 W 1ST ST | ||||||||
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| City: | WACONIA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553871302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9524429770 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1190 WAIANUENUE AVE | ||||||||
| Address2: | |||||||||
| City: | HILO | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967202020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8089746700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2006 | ||||||||
| LastUpdateDate: | 07/03/2008 | ||||||||
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| AuthorizedOfficialLastName: | SAKO | ||||||||
| AuthorizedOfficialFirstName: | RODNEY | ||||||||
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| AuthorizedOfficialTitleorPosition: | BUSINESS OFFICE MGR | ||||||||
| AuthorizedOfficialTelephone: | 8089746700 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 50563801 | 05 | HI | MEDICAID |