1780738005 NPI number — WAIMANALO HEALTH CENTER

Table of content: (NPI 1780738005)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780738005 NPI number — WAIMANALO HEALTH CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WAIMANALO HEALTH CENTER
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:
Provider Other Organization Name Type Code:
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:
1780738005
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
41-1347 KALANIANAOLE HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAIMANALO
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96795-1247
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-954-7107
Provider Business Mailing Address Fax Number:
808-259-6449

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
41-1347 KALANIANAOLE HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAIMANALO
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96795-1247
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-954-7107
Provider Business Practice Location Address Fax Number:
808-259-6449
Provider Enumeration Date:
01/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ONEHA
Authorized Official First Name:
MARY
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
808-954-7107

Provider Taxonomy Codes

  • Taxonomy code: 261QC1500X , with the licence number:  W20416724-01 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 049587 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00C0238901 . This is a "BLUES - CUMMINGS" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 00D0094351 . This is a "HMSA PPO - BHATTACHARYYA" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 00A0080927 . This is a "BLUES - CHAN" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 00D0094351 . This is a "BLUES - BHATTACHARYYA" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 04958701 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0054794522 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0000212407 . This is a "BLUES - HATAKEYAMA" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 0000228100 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0007253302 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0055795200 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00D0245664 . This is a "HMSA - AGULLANA" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 0006095000 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00D0245664 . This is a "BLUES - AGULLANA" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".




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