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General NPI Number Information
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NPI Number | 1134660582
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Entity Type | Organization
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Legal Business Name | BIG ISLAND PSYCHIATRY LLC
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Dates
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Enumeration Date | 03/18/2017
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Last Update Date | 03/18/2017
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Provider Practice Location Address
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Address Line | 65-1230 MAMALAHOA HWY STE D21
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City | KAMUELA
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State | HI
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Zip | 96743-8318
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Country | US
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Telephone | 253-678-5715
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 23
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City | PAHOA
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State | HI
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Zip | 96778-0023
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Country | US
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Telephone | 253-678-5715
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHANNING SCOTT SLATE
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Credential | M.D.
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Telephone | 253-678-5715
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | MD-18550
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License Number State | HI
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