1679540264 NPI number — CASTLE MEDICAL CENTER

Table of content: (NPI 1679540264)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679540264 NPI number — CASTLE MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CASTLE MEDICAL CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679540264
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/07/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
46 001 KAMEHAMEHA HWY
Provider Second Line Business Mailing Address:
SUITE 108
Provider Business Mailing Address City Name:
KANEOHE
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96744
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-263-5093
Provider Business Mailing Address Fax Number:
808-263-5092

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
46 001 KAMEHAMEHA HWY
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
KANEOHE
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96744
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-263-5090
Provider Business Practice Location Address Fax Number:
808-247-1785
Provider Enumeration Date:
03/02/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
NICOLAS
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
808-263-5142

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: PHY531 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1202136 . This is a "NCPDP (NATIONAL COUNCIL FOR PRESCRIPTION DRUG PROGRAMS)" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2018180 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 08205901 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".