| Phoenix Center Inc | |
|
169 Puueo St Hilo HI 96720-2432 | |
| (808) 934-7355 | |
| (808) 935-3209 |
| Full Name | Phoenix Center Inc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 169 Puueo St, Hilo, Hawaii |
| Authorized Official Name and Position | Shelley E. Ham (PRESIDENT) |
| Authorized Official Contact | 8089347355 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Phoenix Center Inc Po Box 10840 Hilo HI 96721-5840 Ph: (808) 934-7355 | Phoenix Center Inc 169 Puueo St Hilo HI 96720-2432 Ph: (808) 934-7355 |
| NPI Number | 1699849422 |
|---|---|
| Provider Enumeration Date | 11/20/2006 |
| Last Update Date | 12/12/2023 |
| Certification Date | 11/29/2023 |
| Medicare PECOS PAC ID | 3870484702 |
|---|---|
| Medicare Enrollment ID | O20040322000947 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699849422 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | LCSW3200 (Hawaii) | Secondary |
| 2084P0800X | Psychiatry & Neurology - Psychiatry | MD8985 (Hawaii) | Primary |
| Provider Name | Shelley E Ham |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1285718411 PECOS PAC ID: 7315838257 Enrollment ID: I20040621000069 |
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