Provider Demographics
NPI:1861823031
Name:KULA HOSPITAL
Entity Type:Organization
Organization Name:KULA HOSPITAL
Other - Org Name:HAWAII HEALTH SYSTEMS CORPORATION
Other - Org Type:Other Name
Authorized Official - Title/Position:MAUI MEMORIAL MEDICAL CENTER CEO
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 1:100 KEOKEA PL
Mailing Address - Street 2:
Mailing Address - City:KULA
Mailing Address - State:HI
Mailing Address - Zip Code:96790-7450
Mailing Address - Country:US
Mailing Address - Phone:808-878-1221
Mailing Address - Fax:808-876-4438
Practice Address - Street 1:100 KEOKEA PL
Practice Address - Street 2:
Practice Address - City:KULA
Practice Address - State:HI
Practice Address - Zip Code:96790-7450
Practice Address - Country:US
Practice Address - Phone:808-878-1221
Practice Address - Fax:808-876-4438
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HAWAII HEALTH SYSTEMS CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-12-12
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI35N282E00000X
HI25H282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
No282NR1301XHospitalsGeneral Acute Care HospitalRural
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI592289Medicaid
HI578271Medicaid
HI592297Medicaid
HI578271Medicaid
HI592289Medicaid
HI1912904681Medicare Oscar/Certification
HI592297Medicaid
HI1215081849Medicare Oscar/Certification
HI1164596904Medicare Oscar/Certification
HI1578680567Medicare Oscar/Certification
HI1003905092Medicare Oscar/Certification
HI1417990052Medicare Oscar/Certification
HI1639257793Medicare Oscar/Certification
HI12Z308Medicare PIN
HI125003Medicare PIN
HI1295813350Medicare Oscar/Certification
HI121308Medicare PIN