Provider Demographics
NPI:1083200232
Name:SAMUEL MAHELONA MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:SAMUEL MAHELONA MEMORIAL HOSPITAL
Other - Org Name:HHSC - KAUAI REGION CLINICS THE CLINIC AT POIPU
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL CFO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ASATO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-338-9407
Mailing Address - Street 1:PO BOX 337
Mailing Address - Street 2:
Mailing Address - City:WAIMEA
Mailing Address - State:HI
Mailing Address - Zip Code:96796-0337
Mailing Address - Country:US
Mailing Address - Phone:808-338-9431
Mailing Address - Fax:808-338-9420
Practice Address - Street 1:2829 ALA KALANI KAUMAKA ST STE B-201
Practice Address - Street 2:
Practice Address - City:KOLOA
Practice Address - State:HI
Practice Address - Zip Code:96756-7549
Practice Address - Country:US
Practice Address - Phone:808-742-0999
Practice Address - Fax:808-742-0990
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAMUEL MAHELONA MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-12-11
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health