Provider Demographics
NPI:1689696395
Name:KALIHI-PALAMA HEALTH CENTER
Entity Type:Organization
Organization Name:KALIHI-PALAMA HEALTH CENTER
Other - Org Name:SUMNER HCHP
Other - Org Type:Other Name
Authorized Official - Title/Position:PATIENT ACCOUNTING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:K
Authorized Official - Last Name:LANCASTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-531-6322
Mailing Address - Street 1:915 N KING ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-4544
Mailing Address - Country:US
Mailing Address - Phone:808-843-7239
Mailing Address - Fax:808-841-1265
Practice Address - Street 1:350 SUMNER ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-5087
Practice Address - Country:US
Practice Address - Phone:808-843-7239
Practice Address - Fax:808-841-1265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIW20300018-01261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI51863105Medicaid
121803Medicare ID - Type Unspecified