MEDICARE: MANUA HEALTH SYSTEM, 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	170100000X	Ph.D. Medical Genetics	3140	AS

General Provider Information

NPI Number	:	1578807798
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MANUA HEALTH SYSTEM, INC

Provider Business Mailing Address
First Line	:	41-1300 WAIKUPANAHA ST
Second Line	:
City	:	WAIMANALO
State	:	HI
Zip	:	96795
Country	:	US
Telephone Number	:	808-259-6309
Fax Number	:	808-440-5606

Provider Business Practice Location Address
First Line	:	102 LUMA TAI RD, TA'U VILLAGE
Second Line	:
City	:	MANU'A ISLAND
State	:	AS
Zip	:	96799
Country	:	US
Telephone Number	:	684-677-3513
Fax Number	:	684-677-3555

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER/CMO
Name	:	DR. MALOUAMAUA PULEISILI TUIOLOSEGA
Credential	:	MD,MB,BS,PCP
Telephone Number	:	684-770-9264

Provider Enumeration Date	:	11/15/2012
Last Update Date	:	11/15/2012

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