Provider Demographics
NPI:1780757856
Name:HILO BENIOFF MEDICAL CENTER
Entity type:Organization
Organization Name:HILO BENIOFF MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JONI
Authorized Official - Middle Name:
Authorized Official - Last Name:WALTJEN
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:808-932-3110
Mailing Address - Street 1:1190 WAIANUENUE AVE
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-2020
Mailing Address - Country:US
Mailing Address - Phone:808-974-6700
Mailing Address - Fax:808-932-3000
Practice Address - Street 1:1190 WAIANUENUE AVE
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2020
Practice Address - Country:US
Practice Address - Phone:808-932-3000
Practice Address - Fax:808-974-6723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIOHCA# 34-H282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0005033OtherHMSA IP
HIR005034OtherHMSAQUEST ASC
HI251745Medicaid
HI0005033OtherHMSAQUEST IP
HIH005036OtherHMSA OP
HI251745OtherALOHACARE
HIR005034OtherHMSA ASC
HI251745Medicaid
HI0005033OtherHMSAQUEST IP