Provider Demographics
NPI:1215143672
Name:KULA HOSPITAL
Entity type:Organization
Organization Name:KULA HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:NILES
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATION
Authorized Official - Phone:808-876-4307
Mailing Address - Street 1:100 KEOKEA PL
Mailing Address - Street 2:
Mailing Address - City:KULA
Mailing Address - State:HI
Mailing Address - Zip Code:96790-7450
Mailing Address - Country:US
Mailing Address - Phone:808-876-4307
Mailing Address - Fax:808-878-1791
Practice Address - Street 1:100 KEOKEA PL
Practice Address - Street 2:
Practice Address - City:KULA
Practice Address - State:HI
Practice Address - Zip Code:96790-7450
Practice Address - Country:US
Practice Address - Phone:808-876-4307
Practice Address - Fax:808-878-1791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPHY-58333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI1639257793OtherNPI HOSPITAL
HI002375-01Medicaid
HI1204293OtherNCPDP PHARMACY
HI578271Medicaid
HI002375-01Medicaid
HI121308Medicare ID - Type UnspecifiedMEB OUTPATIENT
HI125003Medicare Oscar/Certification
HI12Z308Medicare Oscar/Certification