Provider Demographics
NPI:1588631170
Name:CASTLE MEDICAL CENTER
Entity Type:Organization
Organization Name:CASTLE MEDICAL CENTER
Other - Org Name:ADVENTIST HEALTH CASTLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FINANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:HEIDAR
Authorized Official - Middle Name:
Authorized Official - Last Name:THORDARSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-236-5142
Mailing Address - Street 1:642 ULUKAHIKI ST
Mailing Address - Street 2:STE 101
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-4400
Mailing Address - Country:US
Mailing Address - Phone:808-263-5060
Mailing Address - Fax:808-263-5065
Practice Address - Street 1:642 ULUKAHIKI ST
Practice Address - Street 2:STE 101
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734
Practice Address - Country:US
Practice Address - Phone:808-263-5060
Practice Address - Fax:808-263-5065
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CASTLE MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-03-02
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
HIPHY6363336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1204370OtherNCPDP (NATIONAL COUNCIL FOR PRESCRIPTION DRUGS PROGRAMS)
2019360OtherPK
HI52187401Medicaid