Healthcare Provider Details

I. General information

NPI: 1205151818
Provider Name (Legal Business Name): HAWAII PET IMAGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2010
Last Update Date: 04/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1029 KAPAHULU AVE STE 500
HONOLULU HI
96816-1332
US

IV. Provider business mailing address

PO BOX 1300
HONOLULU HI
96807-1300
US

V. Phone/Fax

Practice location:
  • Phone: 808-591-1504
  • Fax: 808-591-1506
Mailing address:
  • Phone: 888-385-5191
  • Fax: 509-479-4992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number10667130
License Number StateHI

VIII. Authorized Official

Name: MR. SCOTT B HALLIDAY
Title or Position: PRESIDENT OF NMD (MEMBER)
Credential:
Phone: 206-272-3580