Healthcare Provider Details

I. General information

NPI: 1164083374
Provider Name (Legal Business Name): KAU HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2019
Last Update Date: 08/14/2020
Certification Date: 08/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1285 WAIANUENUE AVE
HILO HI
96720-1209
US

IV. Provider business mailing address

PO BOX 40
PAHALA HI
96777-0040
US

V. Phone/Fax

Practice location:
  • Phone: 808-932-3940
  • Fax: 808-933-0011
Mailing address:
  • Phone: 808-932-3801
  • Fax: 808-935-1889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LAURI ELIZABETH REDUS
Title or Position: REGIONAL RHC ADMINISTRATOR
Credential:
Phone: 808-932-3801