Provider Demographics
NPI:1477519908
Name:SUTTER HEALTH PACIFIC
Entity Type:Organization
Organization Name:SUTTER HEALTH PACIFIC
Other - Org Name:KAHI MOHALA HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:R
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:808-671-8511
Mailing Address - Street 1:91-2301 FORT WEAVER RD
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-3602
Mailing Address - Country:US
Mailing Address - Phone:808-671-8511
Mailing Address - Fax:808-677-2570
Practice Address - Street 1:91-2301 FORT WEAVER RD
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-3602
Practice Address - Country:US
Practice Address - Phone:808-671-8511
Practice Address - Fax:808-677-2570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-24
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI33-H283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0006220245OtherAETNA
HI508129Medicaid
HI=========0002OtherTRICARE RESIDENTIAL
HI=========0009OtherTRICARE WPS - RESIDENTIAL
HI0006220245OtherAETNA
HI=========0008OtherTRICARE WPS-ACUTE
HI=========0000OtherTRICARE ACUTE
HI=========0009OtherTRICARE WPS - RESIDENTIAL