Basic Information
| Provider Information | |||||||||
| NPI: | 1467510743 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KAUAI VETERANS MEMORIAL HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 337 | ||||||||
| Address2: | |||||||||
| City: | WAIMEA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968960337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8083389431 | ||||||||
| FaxNumber: | 8083389420 | ||||||||
| Practice Location | |||||||||
| Address1: | 4643 WAIMEA CANYON DRIVE | ||||||||
| Address2: | |||||||||
| City: | WAIMEA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967960337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8083389431 | ||||||||
| FaxNumber: | 8083389420 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2006 | ||||||||
| LastUpdateDate: | 08/13/2020 | ||||||||
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| AuthorizedOfficialLastName: | ASATO | ||||||||
| AuthorizedOfficialFirstName: | CHRISTINE | ||||||||
| AuthorizedOfficialMiddleName: | MARIE | ||||||||
| AuthorizedOfficialTitleorPosition: | REGIONAL CFO | ||||||||
| AuthorizedOfficialTelephone: | 8083389407 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 08/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC0060X | 21-H | HI | Y | Hospitals | General Acute Care Hospital | Critical Access |
ID Information
| ID | Type | State | Issuer | Description | 508145 | 05 | HI | MEDICAID |