Provider Demographics
NPI:1578519112
Name:BIG ISLAND HEARING CENTER, LLC
Entity Type:Organization
Organization Name:BIG ISLAND HEARING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:Y
Authorized Official - Last Name:CHING
Authorized Official - Suffix:
Authorized Official - Credentials:MSPA
Authorized Official - Phone:808-935-1299
Mailing Address - Street 1:9 LEI ST
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-4143
Mailing Address - Country:US
Mailing Address - Phone:808-935-1299
Mailing Address - Fax:808-961-3452
Practice Address - Street 1:9 LEI ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-4143
Practice Address - Country:US
Practice Address - Phone:808-935-1299
Practice Address - Fax:808-961-3452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI231H00000X231H00000X
HI237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Not Answered237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI565624Medicaid
HI100448Medicare ID - Type Unspecified