Provider Demographics
NPI:1851364731
Name:PALI MOMI MEDICAL CENTER
Entity Type:Organization
Organization Name:PALI MOMI MEDICAL CENTER
Other - Org Name:PALI MOMI MEDICAL CENTER OUTPATIENT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EVP & CFO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:Y
Authorized Official - Last Name:OKABE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-535-7202
Mailing Address - Street 1:98-1079 MOANALUA RD STE 150
Mailing Address - Street 2:
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-4714
Mailing Address - Country:US
Mailing Address - Phone:808-840-5660
Mailing Address - Fax:
Practice Address - Street 1:98 1079 MOANALUA RD
Practice Address - Street 2:MOB SUITE 150
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701
Practice Address - Country:US
Practice Address - Phone:808-840-5660
Practice Address - Fax:808-485-1700
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PALI MOMI MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-09
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI574203Medicaid
2019432OtherPK
HI574203Medicaid