Provider Demographics
NPI:1790858371
Name:WINDWARD MEDICAL CENTER INC
Entity type:Organization
Organization Name:WINDWARD MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER AND CORPORATE SECR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DANA
Authorized Official - Middle Name:S
Authorized Official - Last Name:SEBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-536-3222
Mailing Address - Street 1:2324 NUUANU AVE
Mailing Address - Street 2:EOMC WMC BUSINESS OFFICE
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-1714
Mailing Address - Country:US
Mailing Address - Phone:808-536-3222
Mailing Address - Fax:808-545-3099
Practice Address - Street 1:407 ULUNIU ST
Practice Address - Street 2:SUITE 103
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2530
Practice Address - Country:US
Practice Address - Phone:808-261-9700
Practice Address - Fax:808-261-9609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI10852207Q00000X
HIMD3219207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
151418OtherHMSA
HI50329401Medicaid
HI045209Medicaid
HI493495Medicaid
151418OtherHMSA
HI=========96734B001OtherTRICARE
HI50329401Medicaid
HI=========OtherHMAA
D31371Medicare UPIN
D36321Medicare UPIN
HI493495Medicaid