Healthcare Provider Details

I. General information

NPI: 1558424473
Provider Name (Legal Business Name): PLANNED PARENTHOOD GREAT NORTHWEST, HAWAI'I, ALASKA, INDIANA, KENTUCKY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

839 S BERETANIA ST
HONOLULU HI
96813-2501
US

IV. Provider business mailing address

1100 W 42ND ST STE 215
INDIANAPOLIS IN
46208-3391
US

V. Phone/Fax

Practice location:
  • Phone: 800-769-0045
  • Fax:
Mailing address:
  • Phone: 317-210-9125
  • Fax: 317-576-2259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number StateHI
# 3
Primary TaxonomyY
Taxonomy Code261QF0050X
TaxonomyNon-Surgical Family Planning Clinic/Center
License Number
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number
License Number StateHI

VIII. Authorized Official

Name: TINA MATTHEWS
Title or Position: MGR - PAYER RELATIONS
Credential:
Phone: 206-861-7571