Provider Demographics
NPI:1902977440
Name:KAU HOSPITAL
Entity Type:Organization
Organization Name:KAU HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MERILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-928-2050
Mailing Address - Street 1:PO BOX 40
Mailing Address - Street 2:
Mailing Address - City:PAHALA
Mailing Address - State:HI
Mailing Address - Zip Code:96777-0040
Mailing Address - Country:US
Mailing Address - Phone:808-928-2050
Mailing Address - Fax:808-928-8980
Practice Address - Street 1:1 KAMANI STREET
Practice Address - Street 2:
Practice Address - City:PAHALA
Practice Address - State:HI
Practice Address - Zip Code:96777
Practice Address - Country:US
Practice Address - Phone:808-928-2050
Practice Address - Fax:808-928-8980
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HAWAII HEALTH SYSTEMS CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-13
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI12Z301275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIA005064OtherHMSA65C ACUTE
HI00567501Medicaid
HIH005069OtherHMSA OUTPATIENT
HIK005062OtherHMSA QUEST ICF
HIK005062OtherHMSA QUEST ICF