Basic Information
| Provider Information | |||||||||
| NPI: | 1689643553 | ||||||||
| 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: | 03/14/2006 | ||||||||
| LastUpdateDate: | 04/20/2008 | ||||||||
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| AuthorizedOfficialLastName: | OLDEN | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | D. | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 8086218411 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 9-H | HI | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 00I0005257 | 01 | HI | HMSA/ ASU/OR SVCS | OTHER | 00U0005258 | 01 | HI | HMSA QUEST SNF/ICF ANC | OTHER | 0049036801 | 05 | HI | MEDICAID | 00H0005259 | 01 | HI | HMSA & 65C OUTPT & SNF/IC | OTHER | 49036801 | 01 | HI | ALOHACARE PROVIDER ID | OTHER | 00A0005254 | 01 | HI | HMSA QUEST SNF WL | OTHER | D0005258 | 01 | HI | BCBS HMSA PHARMACY | OTHER | 0000005256 | 01 | HI | HMSA/ ACUTE SVCS | OTHER | 00S0005252 | 01 | HI | HMSA QUEST SNF WL ANC | OTHER | 0017 | 01 | HI | TRICARE OUTPATIENT.ACUTE | OTHER | 00R0005257 | 01 | HI | HMSA QUEST ICF WL | OTHER | 9171 | 01 | HI | TRICARE PRO FEE | OTHER |