MEDICARE: SAMUEL MAHELONA MEMORIAL HOSPITAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center
2	261QR1300X	Rural Health Clinic/Center

General Provider Information

NPI Number	:	1083200232
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAMUEL MAHELONA MEMORIAL HOSPITAL

Provider Business Mailing Address
First Line	:	PO BOX 337
Second Line	:
City	:	WAIMEA
State	:	HI
Zip	:	96796-0337
Country	:	US
Telephone Number	:	808-240-2723
Fax Number	:	808-240-5569

Provider Business Practice Location Address
First Line	:	4463 PAHEE ST STE 206
Second Line	:
City	:	LIHUE
State	:	HI
Zip	:	96766-2000
Country	:	US
Telephone Number	:	808-241-5799
Fax Number	:	808-241-3188

Authorized Official
Title or Position	:	REGIONAL CFO
Name	:	CHRISTINE MARIE ASATO
Credential	:
Telephone Number	:	808-338-9407

Provider Enumeration Date	:	12/11/2020
Last Update Date	:	05/01/2024

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