1821054412 NPI number — HAWAII ENDOSCOPY CENTER LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821054412 NPI number — HAWAII ENDOSCOPY CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HAWAII ENDOSCOPY CENTER LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821054412
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 29960
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HONOLULU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96820
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-362-9772
Provider Business Mailing Address Fax Number:
425-637-4646

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2226 LILIHA STREET
Provider Second Line Business Practice Location Address:
SUITE 407
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96817
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-531-5823
Provider Business Practice Location Address Fax Number:
808-531-5819
Provider Enumeration Date:
04/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HALLIDAY
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
B
Authorized Official Title or Position:
MEMBER OF OWNER
Authorized Official Telephone Number:
800-362-9772

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0000232165 . This is a "MEDICAID HMSA QUEST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 52073501 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 52073501 . This is a "MEDICARE CLASS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 54102 . This is a "MEDICARE CLASS" identifier . This identifiers is of the category "OTHER".
  • Identifier: Z1617 . This is a "MDX" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 0000232165 . This is a "HMSA 65C PLUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: Z1617 . This is a "QUEENS MDS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0000232165 . This is a "HMSA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 52073501 . This is a "MEDICAID HAWAII" identifier . This identifiers is of the category "OTHER".




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