Provider Demographics
NPI:1629167754
Name:MAUI MEMORIAL MEDICAL CENTER
Entity Type:Organization
Organization Name:MAUI MEMORIAL MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:LO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-442-5100
Mailing Address - Street 1:221 MAHALANI STREET
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793
Mailing Address - Country:US
Mailing Address - Phone:808-270-4236
Mailing Address - Fax:808-242-2644
Practice Address - Street 1:221 MAHALANI STREET
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793
Practice Address - Country:US
Practice Address - Phone:808-270-4236
Practice Address - Fax:808-242-2644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIOHCA 3-H282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIB005187OtherICF R/B WAITLIST
HIE005180OtherOUTPATIENT ANGIO
HIE005180OtherHMSA OUTPATIENT SURGERY
HIH005184OtherOUTPATIENT
HIE005180OtherOUTPATIENT ENDO HMSA
HI00005796Medicaid
HIA005189OtherQUEST INPATIENT
HIA005189OtherHMSA 65C
HIA005189OtherINPATIENT
HIG005186OtherSNF FACILITY
HIP005186OtherQUEST ICF ANCIL WAITLIST
HIH005184OtherOUTPATIENT- ASC HMSA
HIO005181OtherSNF R/B WAITLIST
HIC005185OtherSNF ANCIL WAITLIST
HIH005184OtherQUEST OUTPATIENT
HIH005184OtherOUTPATIENT
HI125054Medicare Oscar/Certification