Provider Demographics
NPI:1437227287
Name:KULA HOSPITAL
Entity Type:Organization
Organization Name:KULA HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NERISSA
Authorized Official - Middle Name:GAYLE
Authorized Official - Last Name:GARRITY
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:808-876-4341
Mailing Address - Street 1:1585 KAPIOLANI BLVD. TEAM PRAXIS
Mailing Address - Street 2:ALA MOANA PACIFIC CENTER, SUITE 1800
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-4500
Mailing Address - Country:US
Mailing Address - Phone:808-948-9332
Mailing Address - Fax:808-949-0483
Practice Address - Street 1:100 KEOKEA PL
Practice Address - Street 2:
Practice Address - City:KULA
Practice Address - State:HI
Practice Address - Zip Code:96790-7450
Practice Address - Country:US
Practice Address - Phone:808-876-4331
Practice Address - Fax:808-876-4332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI207Q00000X, 207R00000X
207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI=========OtherTIN