Provider Demographics
NPI:1962467019
Name:BIG ISLAND MEDICAL, INC.
Entity type:Organization
Organization Name:BIG ISLAND MEDICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:R
Authorized Official - Last Name:KORCZYK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-323-3313
Mailing Address - Street 1:81-6645 MAMALAHOA HWY
Mailing Address - Street 2:
Mailing Address - City:KEALAKEKUA
Mailing Address - State:HI
Mailing Address - Zip Code:96750-8190
Mailing Address - Country:US
Mailing Address - Phone:808-323-3313
Mailing Address - Fax:808-322-9281
Practice Address - Street 1:81-6645 MAMALAHOA HWY
Practice Address - Street 2:
Practice Address - City:KEALAKEKUA
Practice Address - State:HI
Practice Address - Zip Code:96750-8190
Practice Address - Country:US
Practice Address - Phone:808-323-3313
Practice Address - Fax:808-322-9281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPMP431332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI571762-01Medicaid
HI0000256594OtherHMSA
HI0000256594OtherHMSA