Provider Demographics
NPI:1811063514
Name:MAUNAKEA MEDICAL SERVICES INC
Entity type:Organization
Organization Name:MAUNAKEA MEDICAL SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:R
Authorized Official - Last Name:HUTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-933-1999
Mailing Address - Street 1:75-5995 KUAKINI HWY
Mailing Address - Street 2:SUITE 515
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-2144
Mailing Address - Country:US
Mailing Address - Phone:808-327-0488
Mailing Address - Fax:808-327-0499
Practice Address - Street 1:75-5995 KUAKINI HWY
Practice Address - Street 2:SUITE 515
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-2144
Practice Address - Country:US
Practice Address - Phone:808-327-0488
Practice Address - Fax:808-327-0499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000202895OtherHMSA - HILO
HIA20289-3OtherHMSA
HI24776301Medicaid
HI24776301Medicaid