1629167754 NPI number — MAUI MEMORIAL MEDICAL CENTER

Table of content: (NPI 1629167754)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629167754 NPI number — MAUI MEMORIAL MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MAUI MEMORIAL MEDICAL 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:
1629167754
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
221 MAHALANI STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAILUKU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96793
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-270-4236
Provider Business Mailing Address Fax Number:
808-242-2644

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
221 MAHALANI STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAILUKU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96793
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-270-4236
Provider Business Practice Location Address Fax Number:
808-242-2644
Provider Enumeration Date:
10/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LO
Authorized Official First Name:
WESLEY
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
808-442-5100

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  OHCA 3-H , 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: B005187 . This is a "ICF R/B WAITLIST" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: E005180 . This is a "OUTPATIENT ANGIO" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: E005180 . This is a "HMSA OUTPATIENT SURGERY" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: H005184 . This is a "OUTPATIENT" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: E005180 . This is a "OUTPATIENT ENDO HMSA" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 00005796 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: A005189 . This is a "QUEST INPATIENT" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: A005189 . This is a "HMSA 65C" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: A005189 . This is a "INPATIENT" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: G005186 . This is a "SNF FACILITY" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: P005186 . This is a "QUEST ICF ANCIL WAITLIST" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: H005184 . This is a "OUTPATIENT- ASC HMSA" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: O005181 . This is a "SNF R/B WAITLIST" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: C005185 . This is a "SNF ANCIL WAITLIST" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: H005184 . This is a "QUEST OUTPATIENT" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".




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