MEDICARE: WEST HAWAII COMMUNITY HEALTH CENTER, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QF0400X	Federally Qualified Health Center (FQHC)		HI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265482624
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST HAWAII COMMUNITY HEALTH CENTER, INC.

Provider Business Mailing Address
First Line	:	75-5751 KUAKINI HWY STE 203
Second Line	:
City	:	KAILUA KONA
State	:	HI
Zip	:	96740-1753
Country	:	US
Telephone Number	:	808-326-5629
Fax Number	:

Provider Business Practice Location Address
First Line	:	15-2866 PAHOA VILLAGE RD
Second Line	:	BLDG C
City	:	PAHOA
State	:	HI
Zip	:	96778-7720
Country	:	US
Telephone Number	:	808-965-9711
Fax Number	:	808-965-6240

Authorized Official
Title or Position	:	CEO
Name	:	RICHARD J TAAFFE
Credential	:
Telephone Number	:	808-326-3884

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	09/12/2023

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