Provider Demographics
NPI:1013195288
Name:BOYD. J. SLOMOFF M.D. INC.
Entity Type:Organization
Organization Name:BOYD. J. SLOMOFF M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:MISS
Authorized Official - First Name:TAMERA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MEZNARICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-738-0501
Mailing Address - Street 1:4348 WAIALAE #565
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816
Mailing Address - Country:US
Mailing Address - Phone:808-738-0501
Mailing Address - Fax:808-738-5821
Practice Address - Street 1:220 S. KING STREET
Practice Address - Street 2:SUITE #980
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813
Practice Address - Country:US
Practice Address - Phone:808-551-5168
Practice Address - Fax:808-521-8046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-09
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD#40632084P0800X
HIMD4063261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIHMSA-B053484OtherHMSA
HI047069801Medicaid
H0000BDJDFMedicare PIN
HIHMSA-B053484OtherHMSA