Basic Information
| Provider Information | |||||||||
| NPI: | 1679045124 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HAWAII HEALTH SYSTEMS CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 669 | ||||||||
| Address2: | |||||||||
| City: | WAIMEA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967960669 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8083389493 | ||||||||
| FaxNumber: | 8083380225 | ||||||||
| Practice Location | |||||||||
| Address1: | 4489 PAPALINA RD | ||||||||
| Address2: | |||||||||
| City: | KALAHEO | ||||||||
| State: | HI | ||||||||
| PostalCode: | 96741 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8083328523 | ||||||||
| FaxNumber: | 8083327050 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/21/2018 | ||||||||
| LastUpdateDate: | 12/21/2018 | ||||||||
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| AuthorizedOfficialLastName: | SEGAWA | ||||||||
| AuthorizedOfficialFirstName: | LANCE | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | REGIONAL CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 8083389431 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | HAWAII HEALTH SYSTEMS CORPORATION | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | CEO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.