| Dr. Russell M Tom LLC | |
|
98-1079 Moanalua Rd Ste 350 Aiea HI 96701-4714 | |
| (808) 487-2277 | |
| (808) 488-5582 |
| Full Name | Dr. Russell M Tom LLC |
|---|---|
| Speciality | Internal Medicine |
| Location | 98-1079 Moanalua Rd Ste 350, Aiea, Hawaii |
| Authorized Official Name and Position | Hien Ramones (BILLER) |
| Authorized Official Contact | 8086297845 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dr. Russell M Tom LLC 98-1079 Moanalua Rd Ste 350 Aiea HI 96701-4714 Ph: (808) 487-2277 | Dr. Russell M Tom LLC 98-1079 Moanalua Rd Ste 350 Aiea HI 96701-4714 Ph: (808) 487-2277 |
| NPI Number | 1659091171 |
|---|---|
| Provider Enumeration Date | 09/02/2022 |
| Last Update Date | 09/02/2022 |
| Certification Date | 09/02/2022 |
| Medicare PECOS PAC ID | 0143690628 |
|---|---|
| Medicare Enrollment ID | O20221227000876 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659091171 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | () | Primary |
| Provider Name | Russell M Tom |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1346258407 PECOS PAC ID: 2769373547 Enrollment ID: I20101214000905 |
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