Provider Demographics
NPI:1225385347
Name:HILO URGENT CARE, LLC
Entity Type:Organization
Organization Name:HILO URGENT CARE, 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:808-969-3051
Mailing Address - Street 1:45 MOHOULI ST
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-7210
Mailing Address - Country:US
Mailing Address - Phone:808-969-3051
Mailing Address - Fax:
Practice Address - Street 1:45 MOHOULI ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-7210
Practice Address - Country:US
Practice Address - Phone:808-969-3051
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-08
Last Update Date:2017-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN1450363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty