Provider Demographics
NPI:1174777916
Name:KAU HOSPITAL
Entity type:Organization
Organization Name:KAU HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:RURAL HEALTH CLINIC PRACTICE ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:LAURI
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:REDUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-932-3801
Mailing Address - Street 1:15-2660 PAHOA VILLAGE ROAD
Mailing Address - Street 2:SUITE 306, PMB 8741
Mailing Address - City:PAHOA
Mailing Address - State:HI
Mailing Address - Zip Code:96778-7802
Mailing Address - Country:US
Mailing Address - Phone:808-965-1801
Mailing Address - Fax:
Practice Address - Street 1:15-2662 PAHOA VILLAGE RD
Practice Address - Street 2:SUITE 301, 303-305, 307
Practice Address - City:PAHOA
Practice Address - State:HI
Practice Address - Zip Code:96778-7730
Practice Address - Country:US
Practice Address - Phone:808-965-1801
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-06
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QR1300X
HI261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI832396Medicaid