Provider Demographics
NPI:1679540264
Name:CASTLE MEDICAL CENTER
Entity type:Organization
Organization Name:CASTLE MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:NICOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-263-5142
Mailing Address - Street 1:46 001 KAMEHAMEHA HWY
Mailing Address - Street 2:SUITE 108
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744
Mailing Address - Country:US
Mailing Address - Phone:808-263-5093
Mailing Address - Fax:808-263-5092
Practice Address - Street 1:46 001 KAMEHAMEHA HWY
Practice Address - Street 2:SUITE 108
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744
Practice Address - Country:US
Practice Address - Phone:808-263-5090
Practice Address - Fax:808-247-1785
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CASTLE MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-03-02
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
HIPHY5313336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1202136OtherNCPDP (NATIONAL COUNCIL FOR PRESCRIPTION DRUG PROGRAMS)
2018180OtherPK
HI08205901Medicaid