Provider Demographics
NPI:1629875349
Name:JOHN A HEASTER
Entity type:Organization
Organization Name:JOHN A HEASTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERTA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MAKAOKALANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-933-3555
Mailing Address - Street 1:122 HAILI ST
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-2804
Mailing Address - Country:US
Mailing Address - Phone:808-933-3555
Mailing Address - Fax:808-934-9630
Practice Address - Street 1:122 HAILI ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2804
Practice Address - Country:US
Practice Address - Phone:808-933-3555
Practice Address - Fax:808-934-9630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-28
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty