Provider Demographics
NPI:1689643553
Name:WAHIAWA GENERAL HOSPITAL
Entity Type:Organization
Organization Name:WAHIAWA GENERAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:D
Authorized Official - Last Name:OLDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-621-8411
Mailing Address - Street 1:128 LEHUA ST
Mailing Address - Street 2:
Mailing Address - City:WAHIAWA
Mailing Address - State:HI
Mailing Address - Zip Code:96786-2036
Mailing Address - Country:US
Mailing Address - Phone:808-621-8411
Mailing Address - Fax:808-621-4117
Practice Address - Street 1:128 LEHUA ST
Practice Address - Street 2:
Practice Address - City:WAHIAWA
Practice Address - State:HI
Practice Address - Zip Code:96786-2036
Practice Address - Country:US
Practice Address - Phone:808-621-8411
Practice Address - Fax:808-621-4117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI9-H282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI00I0005257OtherHMSA/ ASU/OR SVCS
HI00U0005258OtherHMSA QUEST SNF/ICF ANC
HI0049036801Medicaid
HI00H0005259OtherHMSA & 65C OUTPT & SNF/IC
HI49036801OtherALOHACARE PROVIDER ID
HI00A0005254OtherHMSA QUEST SNF WL
HID0005258OtherBCBS HMSA PHARMACY
HI0000005256OtherHMSA/ ACUTE SVCS
HI00S0005252OtherHMSA QUEST SNF WL ANC
HI0017OtherTRICARE OUTPATIENT.ACUTE
HI00R0005257OtherHMSA QUEST ICF WL
HI9171OtherTRICARE PRO FEE
HID0005258OtherBCBS HMSA PHARMACY
HI00I0005257OtherHMSA/ ASU/OR SVCS
HI0017OtherTRICARE OUTPATIENT.ACUTE