Basic Information
| Provider Information | |||||||||
| NPI: | 1609045673 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | WAHIAWA GENERAL HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 128 LEHUA ST | ||||||||
| Address2: | |||||||||
| City: | WAHIAWA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967862036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8086218411 | ||||||||
| FaxNumber: | 8086214117 | ||||||||
| Practice Location | |||||||||
| Address1: | 128 LEHUA ST | ||||||||
| Address2: | |||||||||
| City: | WAHIAWA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967862036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8086218411 | ||||||||
| FaxNumber: | 8086214117 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/25/2008 | ||||||||
| LastUpdateDate: | 02/25/2008 | ||||||||
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| AuthorizedOfficialLastName: | OLDEN | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | D. | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 8086218411 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | WAHIAWA GENERAL HOSPITAL | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332BP3500X | 9-H | HI | N | Suppliers | Durable Medical Equipment & Medical Supplies | Parenteral & Enteral Nutrition | 332B00000X | 9-H | HI | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.