Provider Demographics
NPI:1881695476
Name:QUEEN'S DEVELOPMENT CORPORATION & SUBSIDIARIES
Entity type:Organization
Organization Name:QUEEN'S DEVELOPMENT CORPORATION & SUBSIDIARIES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-691-1980
Mailing Address - Street 1:1380 LUSITANA ST
Mailing Address - Street 2:STREET LEVEL
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2449
Mailing Address - Country:US
Mailing Address - Phone:808-691-4745
Mailing Address - Fax:808-691-4064
Practice Address - Street 1:1380 LUSITANA ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2449
Practice Address - Country:US
Practice Address - Phone:808-547-4745
Practice Address - Fax:808-547-4064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-03
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPHY-470333600000X, 332B00000X, 335E00000X, 332BP3500X, 332BD1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Not Answered335E00000XSuppliersProsthetic/Orthotic Supplier
Not Answered332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Not Answered332BD1200XSuppliersDurable Medical Equipment & Medical SuppliesDialysis Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI1201451OtherNCPDP NUMBER
HI1201451OtherNABP NUMBER
HI085392-01OtherHMSA - BLUE CROSS/BLUE SH
HI085392-01Medicaid
HI0655400001Medicare NSC