Provider Demographics
NPI:1801825161
Name:MAUNA KEA MEDICAL SERVICES
Entity Type:Organization
Organization Name:MAUNA KEA MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUTSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:808-933-1999
Mailing Address - Street 1:355 KALANIANAOLE AVE STE A1
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-4738
Mailing Address - Country:US
Mailing Address - Phone:808-933-1999
Mailing Address - Fax:808-933-1799
Practice Address - Street 1:355 KALANIANAOLE AVE STE A1
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-4738
Practice Address - Country:US
Practice Address - Phone:808-933-1999
Practice Address - Fax:808-933-1799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPMP256332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000202895OtherHMSA HILO
HI24776301Medicaid
HI24776301Medicaid