Basic Information
| Provider Information | |||||||||
| NPI: | 1184210932 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SAMUEL MAHELONA MEMORIAL HOSPITAL | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| OtherOrganizationName: | HHSC - KAUAI REGION CLINICS THE CLINIC AT KALAHEO | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 337 | ||||||||
| Address2: | |||||||||
| City: | WAIMEA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967960337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8083389431 | ||||||||
| FaxNumber: | 8083389420 | ||||||||
| Practice Location | |||||||||
| Address1: | 4489 PAPALINA RD | ||||||||
| Address2: | |||||||||
| City: | KALAHEO | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967412001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8083328523 | ||||||||
| FaxNumber: | 8083327050 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/16/2020 | ||||||||
| LastUpdateDate: | 01/29/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | ASATO | ||||||||
| AuthorizedOfficialFirstName: | CHRISTINE | ||||||||
| AuthorizedOfficialMiddleName: | MARIE | ||||||||
| AuthorizedOfficialTitleorPosition: | REGIONAL CFO | ||||||||
| AuthorizedOfficialTelephone: | 8083389407 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SAMUEL MAHELONA MEMORIAL HOSPITAL | ||||||||
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| NPICertificationDate: | 01/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | N | Ambulatory Health Care Facilities | Clinic/Center | Rural Health | 261Q00000X | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.