Provider Demographics
NPI:1184612764
Name:THE QUEENS MEDICAL CENTER
Entity type:Organization
Organization Name:THE QUEENS MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXEC VP/CHIEF FINANCE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:PANKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-691-5957
Mailing Address - Street 1:1301 PUNCHBOWL ST
Mailing Address - Street 2:ATTN: MANAGED CARE CONTRACTING
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2499
Mailing Address - Country:US
Mailing Address - Phone:808-691-5949
Mailing Address - Fax:
Practice Address - Street 1:1301 PUNCHBOWL ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813
Practice Address - Country:US
Practice Address - Phone:808-538-9011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-07
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI273R00000X, 323P00000X
HI29-H282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No273R00000XHospital UnitsPsychiatric Unit
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIN4091OtherHMSA QUEST DAY TREATMENT
HIZ4091-6OtherHMSA QUEST ICF LEVEL R&B
HI490417-01Medicaid
HID4091-7OtherHMSA QUEST SNF LEVEL R&B
HIH4091-8OtherHMSA OUTPATIENT
HI0020OtherTRICARE HOSPITAL
HIT2469-9OtherHMSA QUEST PUCC
HIS4091OtherHMSA DENTAL
HIU4091-7OtherHMSA ASC
HI02469-5OtherHMSA 65C OP MEDICARE ADV
HI120001OtherHMSA 65C MEDICARE ADVANT
HIB4091-1OtherHMSA OP PHARMACY
HIU4091-7OtherHMSA QUEST ASC
HIH4091-8OtherHMSA DAY TREATMENT
HIK4091-1OtherHMSA QUEST SNF & ICF ANC
HIN4091-4OtherHMSA IP HOSPITAL
HIH4091-8OtherHMSA QUEST OP HOSPITAL
HIN4091-4OtherHMSA QUEST IP HOSPITAL
HI02469-5OtherHMSA 65C+ OP MEDICARE ADV
HIN4091-4OtherHMSA QUEST IP HOSPITAL