Healthcare Provider Details

I. General information

NPI: 1366916868
Provider Name (Legal Business Name): HAWAII HEALTH SYSTEMS CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2019
Last Update Date: 01/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4353 WAIALO RD
ELEELE HI
96705
US

IV. Provider business mailing address

PO BOX 669
WAIMEA HI
96796-0669
US

V. Phone/Fax

Practice location:
  • Phone: 808-335-0579
  • Fax: 808-335-0581
Mailing address:
  • Phone: 808-338-9493
  • Fax: 808-338-0225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. LANCE K SEGAWA
Title or Position: REGIONAL CHIEF EXECUTIVE OFFICER
Credential: CEO
Phone: 808-338-9431