Basic Information
| Provider Information | |||||||||
| NPI: | 1619038536 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SAMUEL MAHELONA MEMORIAL HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4800 KAWAIHAU ROAD | ||||||||
| Address2: | |||||||||
| City: | KAPAA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 96746 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8083389431 | ||||||||
| FaxNumber: | 8083389420 | ||||||||
| Practice Location | |||||||||
| Address1: | 4800 KAWAIHAU ROAD | ||||||||
| Address2: | |||||||||
| City: | KAPAA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 96746 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8083389431 | ||||||||
| FaxNumber: | 8083389420 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2006 | ||||||||
| LastUpdateDate: | 11/16/2016 | ||||||||
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| AuthorizedOfficialLastName: | LORENZO | ||||||||
| AuthorizedOfficialFirstName: | RACHELLE | ||||||||
| AuthorizedOfficialMiddleName: | M D | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 8083389431 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC0060X | 22-H | HI | Y | Hospitals | General Acute Care Hospital | Critical Access |
ID Information
| ID | Type | State | Issuer | Description | 578601 | 05 | HI | MEDICAID |