Healthcare Provider Details

I. General information

NPI: 1952335630
Provider Name (Legal Business Name): WEST HAWAII COMMUNITY HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 09/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75-5751 KUAKINI HWY SUITE 203
KAILUA-KONA HI
96740-1752
US

IV. Provider business mailing address

75-5751 KUAKINI HWY STE 203
KAILUA KONA HI
96740-1752
US

V. Phone/Fax

Practice location:
  • Phone: 808-326-3883
  • Fax: 808-329-9370
Mailing address:
  • Phone: 808-326-3883
  • Fax: 808-329-9370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MR. RICHARD J TAAFFE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 808-326-5629