1639217300 NPI number — HAWAII HEALTH SYSTEMS CORP

Table of content: (NPI 1639217300)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639217300 NPI number — HAWAII HEALTH SYSTEMS CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HAWAII HEALTH SYSTEMS CORP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
KONA COMMUNITY HOSPITAL PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639217300
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/20/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
79 1019 HAUKAPILA ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KEALAKEKUA
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96750
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-322-4470
Provider Business Mailing Address Fax Number:
808-322-4599

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
79 1019 HAUKAPILA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KEALAKEKUA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96750
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-322-4470
Provider Business Practice Location Address Fax Number:
808-322-4599
Provider Enumeration Date:
02/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PASSON
Authorized Official First Name:
MARLINDA
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
808-322-9311

Provider Taxonomy Codes

  • Taxonomy code: 3336I0012X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X , with the licence number: PHY-226 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 05157 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00577401 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2018907 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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