Provider Demographics
NPI:1932123551
Name:HAWAII ISLAND INTERVENTIONAL PAIN MANAGEMENT, INC
Entity Type:Organization
Organization Name:HAWAII ISLAND INTERVENTIONAL PAIN MANAGEMENT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:W
Authorized Official - Last Name:RUHLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-933-3400
Mailing Address - Street 1:80 PAUAHI ST
Mailing Address - Street 2:#104
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-3025
Mailing Address - Country:US
Mailing Address - Phone:808-933-3400
Mailing Address - Fax:808-933-3401
Practice Address - Street 1:80 PAUAHI ST
Practice Address - Street 2:#104
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-3025
Practice Address - Country:US
Practice Address - Phone:808-933-3400
Practice Address - Fax:808-933-3401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI30131514174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIH55273Medicare ID - Type Unspecified