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General NPI Number Information
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NPI Number | 1417377649
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Entity Type | Organization
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Legal Business Name | PACIFIC ENDOSCOPY CENTER LLC
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Dates
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Enumeration Date | 04/28/2014
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Last Update Date | 11/10/2024
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Provider Practice Location Address
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Address Line | 134 PUUHONU WAY
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City | HILO
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State | HI
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Zip | 96720-2066
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Country | US
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Telephone | 808-969-3979
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Fax | 808-531-5819
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Provider Business Mailing Address
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Address Line | 134 PUUHONU WAY
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City | HILO
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State | HI
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Zip | 96720-2066
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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 | OFFICER/AO
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Name | ERIC BOON
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Credential |
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Telephone | 480-567-0269
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | FSOF-9
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License Number State | HI
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