# BAY CARE MED CORP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1568694180
- **Authorized official:** JED A GROOM (CEO)
- **Authorized official phone:** (808) 206-5349

## Contact information

- **Practice address:** 16-540 KEAAU PAHOA RD, STE 2-177, KEAAU, HI 96749-8155
- **Practice address phone:** (808) 206-5349
- **Mailing address:** 16-540 KEAAU PAHOA RD, STE 2-177, KEAAU, HI 96749-8155

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | MD4251 | HI | Yes |

## Other

- **Enumeration date:** 08/14/2009
- **Last updated:** 01/15/2010