Provider Demographics
NPI:1609949775
Name:HILO MEDICAL CENTER
Entity Type:Organization
Organization Name:HILO MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHURRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-974-4729
Mailing Address - Street 1:1190 WAIANUENUE AVE
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-2020
Mailing Address - Country:US
Mailing Address - Phone:808-974-6700
Mailing Address - Fax:808-974-6723
Practice Address - Street 1:1190 WAIANUENUE AVE
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2020
Practice Address - Country:US
Practice Address - Phone:808-974-6700
Practice Address - Fax:808-974-6723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIOHCA# 44-N313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIE005032OtherHMSAQUEST SNF
HIT005037OtherHMSAQUEST ICF WL
HIU005035OtherHMSAQUEST ICF ANC
HID005035OtherHMSAQUEST ICF
HIN005032OtherHMSAQUEST ANC
HI251745OtherALOHACARE
HIA005031OtherHMSAQUEST SNF WL
HI251745Medicaid
HIE005032OtherHMSA SNF
HIP005038OtherHMSAQUEST ICF WL
HI=========OtherALL OTHERS
HIN005032OtherHMSAQUEST ANC