Basic Information
| Provider Information | |||||||||
| NPI: | 1629167754 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MAUI MEMORIAL MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 221 MAHALANI STREET | ||||||||
| Address2: | |||||||||
| City: | WAILUKU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 96793 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8082704236 | ||||||||
| FaxNumber: | 8082422644 | ||||||||
| Practice Location | |||||||||
| Address1: | 221 MAHALANI STREET | ||||||||
| Address2: | |||||||||
| City: | WAILUKU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 96793 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8082704236 | ||||||||
| FaxNumber: | 8082422644 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | LO | ||||||||
| AuthorizedOfficialFirstName: | WESLEY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 8084425100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | OHCA 3-H | HI | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | B005187 | 01 | HI | ICF R/B WAITLIST | OTHER | E005180 | 01 | HI | OUTPATIENT ANGIO | OTHER | E005180 | 01 | HI | HMSA OUTPATIENT SURGERY | OTHER | H005184 | 01 | HI | OUTPATIENT | OTHER | E005180 | 01 | HI | OUTPATIENT ENDO HMSA | OTHER | 00005796 | 05 | HI | MEDICAID | A005189 | 01 | HI | QUEST INPATIENT | OTHER | A005189 | 01 | HI | HMSA 65C | OTHER | A005189 | 01 | HI | INPATIENT | OTHER | G005186 | 01 | HI | SNF FACILITY | OTHER | P005186 | 01 | HI | QUEST ICF ANCIL WAITLIST | OTHER | H005184 | 01 | HI | OUTPATIENT- ASC HMSA | OTHER | O005181 | 01 | HI | SNF R/B WAITLIST | OTHER | C005185 | 01 | HI | SNF ANCIL WAITLIST | OTHER | H005184 | 01 | HI | QUEST OUTPATIENT | OTHER |