Provider Demographics
NPI:1255683785
Name:BIG ISLAND PAIN CENTER INC.
Entity Type:Organization
Organization Name:BIG ISLAND PAIN CENTER INC.
Other - Org Name:PUANA PAIN CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:PUANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-934-9675
Mailing Address - Street 1:2510 S ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-6230
Mailing Address - Country:US
Mailing Address - Phone:808-934-9675
Mailing Address - Fax:
Practice Address - Street 1:32 ULULANI ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2933
Practice Address - Country:US
Practice Address - Phone:808-934-9675
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-08
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM2500X
HIW5908947001261QP3300X, 261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI62644205Medicaid