Basic Information
| Provider Information | |||||||||
| NPI: | 1952335630 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WEST HAWAII COMMUNITY HEALTH CENTER, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 75-5751 KUAKINI HWY | ||||||||
| Address2: | STE 203 | ||||||||
| City: | KAILUA KONA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967401752 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8083263883 | ||||||||
| FaxNumber: | 8083299370 | ||||||||
| Practice Location | |||||||||
| Address1: | 75-5751 KUAKINI HWY | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | KAILUA-KONA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967401752 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8083263883 | ||||||||
| FaxNumber: | 8083299370 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2006 | ||||||||
| LastUpdateDate: | 09/26/2012 | ||||||||
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| AuthorizedOfficialLastName: | TAAFFE | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8083265629 | ||||||||
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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 | 208D00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
No ID Information.