Healthcare Provider Details

I. General information

NPI: 1437227287
Provider Name (Legal Business Name): KULA HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 01/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 KEOKEA PL
KULA HI
96790-7450
US

IV. Provider business mailing address

1585 KAPIOLANI BLVD. TEAM PRAXIS ALA MOANA PACIFIC CENTER, SUITE 1800
HONOLULU HI
96814-4500
US

V. Phone/Fax

Practice location:
  • Phone: 808-876-4331
  • Fax: 808-876-4332
Mailing address:
  • Phone: 808-948-9332
  • Fax: 808-949-0483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateHI
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. NERISSA GAYLE GARRITY
Title or Position: BUSINESS MANAGER
Credential: MBA
Phone: 808-876-4341