1689643553 NPI number — WAHIAWA GENERAL HOSPITAL

Table of content: (NPI 1689643553)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689643553 NPI number — WAHIAWA GENERAL HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WAHIAWA GENERAL HOSPITAL
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:
1689643553
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
128 LEHUA ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAHIAWA
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96786-2036
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-621-8411
Provider Business Mailing Address Fax Number:
808-621-4117

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
128 LEHUA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAHIAWA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96786-2036
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-621-8411
Provider Business Practice Location Address Fax Number:
808-621-4117
Provider Enumeration Date:
03/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
OLDEN
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
808-621-8411

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  9-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: 00I0005257 . This is a "HMSA/ ASU/OR SVCS" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 00U0005258 . This is a "HMSA QUEST SNF/ICF ANC" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 0049036801 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00H0005259 . This is a "HMSA & 65C OUTPT & SNF/IC" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 49036801 . This is a "ALOHACARE PROVIDER ID" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 00A0005254 . This is a "HMSA QUEST SNF WL" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: D0005258 . This is a "BCBS HMSA PHARMACY" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 0000005256 . This is a "HMSA/ ACUTE SVCS" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 00S0005252 . This is a "HMSA QUEST SNF WL ANC" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 0017 . This is a "TRICARE OUTPATIENT.ACUTE" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 00R0005257 . This is a "HMSA QUEST ICF WL" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 9171 . This is a "TRICARE PRO FEE" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".




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