Provider Demographics
NPI:1053710889
Name:MAUI MEMORIAL MEDICAL CENTER
Entity type:Organization
Organization Name:MAUI MEMORIAL MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHEIF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:LO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-442-5100
Mailing Address - Street 1:221 MAHALANI ST
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-2526
Mailing Address - Country:US
Mailing Address - Phone:808-243-3030
Mailing Address - Fax:808-442-5652
Practice Address - Street 1:221 MAHALANI ST
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-2526
Practice Address - Country:US
Practice Address - Phone:808-243-3030
Practice Address - Fax:808-442-5652
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HAWAII HEALTH SYSTEMS CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-08-18
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIOHCA 3-H282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI00005796Medicaid
H005187OtherOUTPATIENT
A005189OtherQUEST INPATIENT
C005185OtherSNF ANCIL WAITLIST
E005180OtherOUTPATIENT OTHER
P005186OtherQUEST ICF ANCIL WAITLIST
120002OtherMEDICARE ID - TYPE UNSPECIFIED
G005186OtherSNF FACILITY
NCF08508Medicare UPIN
NEE10542Medicare UPIN
HIBT583AMedicare PIN
E005180OtherOUTPATIENT OTHER
ORE72289Medicare UPIN
VAR36294Medicare UPIN
G005186OtherSNF FACILITY
P005186OtherQUEST ICF ANCIL WAITLIST
HIH103779Medicare UPIN
HI125054Medicare Oscar/Certification
C005185OtherSNF ANCIL WAITLIST
MIB44816Medicare UPIN