Provider Demographics
NPI:1255977864
Name:HAWAII SHOULDER AND ORTHOPEDIC INSTITUTE LLC
Entity type:Organization
Organization Name:HAWAII SHOULDER AND ORTHOPEDIC INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING AND CREDENTIALING
Authorized Official - Prefix:MRS
Authorized Official - First Name:RAQUEL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BOROMEO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-987-0404
Mailing Address - Street 1:PO BOX 10742
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96721-5742
Mailing Address - Country:US
Mailing Address - Phone:808-935-3375
Mailing Address - Fax:808-961-0498
Practice Address - Street 1:670 KEKUANAOA ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-4405
Practice Address - Country:US
Practice Address - Phone:808-935-3378
Practice Address - Fax:808-961-0498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-19
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty