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
State | License ID | Taxonomies |
---|---|---|
HI | 261QF0400X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QF0400X | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
HI | 00C0263800 | Other | KALAMA NIHEU, MD - HMSA (PUALALEA) |
HI | 00F0052461 | Other | HARRY ASHE, MD - HMSA |
HI | 00G00228457 | Other | MIRIAM CHANG, MD - HMSA (PUALALEA) |
HI | 50178505 | Medicaid | |
HI | 00E0228451 | Other | MIRIAM CHANG, MD - HMSA |
HI | 00F0228459 | Other | MIRIAM CHANG, MD - HMSA (HAUULA) |
HI | 00G0052469 | Other | HARRY ASHE, MD - HMSA (HAUULA) |
HI | 08802105 | Medicaid | |
HI | 581977 | Medicaid | |
HI | 00A0250603 | Other | KCHWC - HMSA |
HI | 00C0228910 | Other | NATIVIDAD HOPEWELL - HMSA |
HI | 00E0228915 | Other | NATIVIDAD HOPEWELL, APRN - HMSA (PUALALEA) |
HI | 00H0052467 | Other | HARRY ASHE, MD - HMSA (PUALALEA) |
HI | 55384302 | Medicaid | |
HI | 00D0228918 | Other | NATIVIDAD HOPEWELL, APRN - HMSA (HAUULA) |
HI | 50104005 | Medicaid | |
HI | 00A0244754 | Other | BRENDA HARPER, APRN-HMSA |
HI | 00J0205359 | Other | DOUGLAS SUTHERLAND, MD - HMSA (PUALALEA) |
HI | 0000250605 | Other | KCHWC - HMSA |
HI | 00B0214839 | Other | GARY PITT, DPM - HMSA |
HI | 00B0263802 | Other | KALAMA NIHEU, MD - HMSA (HAUULA) |
HI | S90940 | Medicare UPIN | |
HI | 00F0052461 | Other | HARRY ASHE, MD - HMSA |
HI | 00F0228459 | Other | MIRIAM CHANG, MD - HMSA (HAUULA) |
HI | U69888 | Medicare UPIN | |
HI | D43386 | Medicare UPIN | |
HI | 56751 | Medicare ID - Type Unspecified | BRENDA HARPER, APRN |
HI | 00E0228451 | Other | MIRIAM CHANG, MD - HMSA |
HI | 00E0228915 | Other | NATIVIDAD HOPEWELL, APRN - HMSA (PUALALEA) |
HI | 0000250605 | Other | KCHWC - HMSA |
HI | 56745 | Medicare ID - Type Unspecified | HARRY ASHE, MD |
HI | 56749 | Medicare ID - Type Unspecified | MIRIAM CHANG, MD |
HI | 56747 | Medicare ID - Type Unspecified | NATIVIDAD HOPEWELL, APRN |