Provider Demographics
NPI:1285746636
Name:CANCER CENTER OF HAWAII, LLC
Entity type:Organization
Organization Name:CANCER CENTER OF HAWAII, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER/MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:C
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-547-6881
Mailing Address - Street 1:2226 LILIHA ST
Mailing Address - Street 2:LEVEL B-2
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-1600
Mailing Address - Country:US
Mailing Address - Phone:808-547-6881
Mailing Address - Fax:808-547-6583
Practice Address - Street 1:2226 LILIHA ST
Practice Address - Street 2:LEVEL B-2
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-1600
Practice Address - Country:US
Practice Address - Phone:808-547-6881
Practice Address - Fax:808-547-6583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRT0007261QX0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0203XAmbulatory Health Care FacilitiesClinic/CenterOncology, Radiation
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI564395Medicaid
HI0000249045OtherHMSA BASIC
HI0000249045OtherHMSA HMO
HIZ1658OtherMDX
HI0000249045OtherHMSA HMO: HI IPA
HI5673407OtherFIRST HEALTH
HI0000249045OtherHMSA QUEST
HI000249045OtherHMSA 65C AND 65C PLUS
HI55593001OtherALOHACARE
HI55593001OtherALOHACARE
HI564395Medicaid
HI0000249045OtherHMSA QUEST
HI0000249045OtherHMSA BASIC