Provider Demographics
NPI:1528026952
Name:KO OLAULOA HEALTH CENTER
Entity Type:Organization
Organization Name:KO OLAULOA HEALTH CENTER
Other - Org Name:KO'OLAULOA COMMUNITY HEALTH AND WELLNESS CENTER, KAHUKU MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TERRENCE
Authorized Official - Middle Name:H
Authorized Official - Last Name:ARATANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-792-3840
Mailing Address - Street 1:PO BOX 395
Mailing Address - Street 2:
Mailing Address - City:KAHUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96731
Mailing Address - Country:US
Mailing Address - Phone:808-293-9231
Mailing Address - Fax:808-293-5390
Practice Address - Street 1:56-119 PUALALEA ST.
Practice Address - Street 2:
Practice Address - City:KAHUKU
Practice Address - State:HI
Practice Address - Zip Code:96731
Practice Address - Country:US
Practice Address - Phone:808-293-9231
Practice Address - Fax:808-293-5390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI00C0263800OtherKALAMA NIHEU, MD - HMSA (PUALALEA)
HI00F0052461OtherHARRY ASHE, MD - HMSA
HI00G00228457OtherMIRIAM CHANG, MD - HMSA (PUALALEA)
HI50178505Medicaid
HI00E0228451OtherMIRIAM CHANG, MD - HMSA
HI00F0228459OtherMIRIAM CHANG, MD - HMSA (HAUULA)
HI00G0052469OtherHARRY ASHE, MD - HMSA (HAUULA)
HI08802105Medicaid
HI581977Medicaid
HI00A0250603OtherKCHWC - HMSA
HI00C0228910OtherNATIVIDAD HOPEWELL - HMSA
HI00E0228915OtherNATIVIDAD HOPEWELL, APRN - HMSA (PUALALEA)
HI00H0052467OtherHARRY ASHE, MD - HMSA (PUALALEA)
HI55384302Medicaid
HI00D0228918OtherNATIVIDAD HOPEWELL, APRN - HMSA (HAUULA)
HI50104005Medicaid
HI00A0244754OtherBRENDA HARPER, APRN-HMSA
HI00J0205359OtherDOUGLAS SUTHERLAND, MD - HMSA (PUALALEA)
HI0000250605OtherKCHWC - HMSA
HI00B0214839OtherGARY PITT, DPM - HMSA
HI00B0263802OtherKALAMA NIHEU, MD - HMSA (HAUULA)
HIS90940Medicare UPIN
HI00F0052461OtherHARRY ASHE, MD - HMSA
HI00F0228459OtherMIRIAM CHANG, MD - HMSA (HAUULA)
HIU69888Medicare UPIN
HID43386Medicare UPIN
HI56751Medicare ID - Type UnspecifiedBRENDA HARPER, APRN
HI00E0228451OtherMIRIAM CHANG, MD - HMSA
HI00E0228915OtherNATIVIDAD HOPEWELL, APRN - HMSA (PUALALEA)
HI0000250605OtherKCHWC - HMSA
HI56745Medicare ID - Type UnspecifiedHARRY ASHE, MD
HI56749Medicare ID - Type UnspecifiedMIRIAM CHANG, MD
HI56747Medicare ID - Type UnspecifiedNATIVIDAD HOPEWELL, APRN