Healthcare Provider Details

I. General information

NPI: 1972914117
Provider Name (Legal Business Name): HAWAII PET IMAGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2014
Last Update Date: 05/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98-1247 KAAHUMANU ST SUITE 320
AIEA HI
96701-5311
US

IV. Provider business mailing address

5001 25TH AVE NE 202
SEATTLE WA
98105-5661
US

V. Phone/Fax

Practice location:
  • Phone: 808-591-1504
  • Fax: 808-591-1506
Mailing address:
  • Phone: 206-272-3580
  • Fax: 206-272-3588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License NumberW20190908
License Number StateHI

VIII. Authorized Official

Name: MR. SCOTT B HALLIDAY
Title or Position: PRESIDENT
Credential:
Phone: 206-272-3580