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General NPI Number Information
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NPI Number | 1235730797
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Entity Type | Organization
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Legal Business Name | ELEVATION MEDICAL IMAGING HAWAII LLC
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Dates
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Enumeration Date | 11/02/2020
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Last Update Date | 11/02/2020
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Provider Practice Location Address
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Address Line | 68-1820 WAIKOLOA RD STE M101M102
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City | WAIKOLOA
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State | HI
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Zip | 96738
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Country | US
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Telephone | 307-690-1523
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 7377
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City | JACKSON
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State | WY
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Zip | 83002-7377
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | SHAUN ANDRIKOPOULOS
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Credential |
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Telephone | 307-690-1523
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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