Healthcare Provider Details

I. General information

NPI: 1902802234
Provider Name (Legal Business Name): HAWAII PET IMAGING, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 12/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 S BERETANIA ST STE. 107
HONOLULU HI
96814-1870
US

IV. Provider business mailing address

5001 25TH AVE NE STE. 202
SEATTLE WA
98105
US

V. Phone/Fax

Practice location:
  • Phone: 808-590-1504
  • 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 Number10667130
License Number StateHI

VIII. Authorized Official

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