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General NPI Number Information
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NPI Number | 1881362739
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Entity Type | Organization
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Legal Business Name | ISLAND CARDIOVASCULAR & VEIN INSTITUTE LLC
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Dates
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Enumeration Date | 09/03/2021
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Last Update Date | 02/07/2022
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Provider Practice Location Address
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Address Line | 75-5591 PALANI RD STE 2002
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City | KAILUA KONA
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State | HI
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Zip | 96740-3634
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Country | US
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Telephone | 210-218-3328
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Fax |
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Provider Business Mailing Address
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Address Line | 75-5591 PALANI RD STE 2002
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City | KAILUA KONA
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State | HI
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Zip | 96740-3634
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Country | US
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Telephone | 210-218-3328
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Fax |
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Authorized Official
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Title or Position | PRESIDENT PHYSICIAN
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Name | DR. JAMISON WYATT
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Credential | MD
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Telephone | 210-218-3328
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number |
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License Number State |
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