1063470201 NPI number — MAUI DIAGNOSTIC IMAGING LLC

Table of content: (NPI 1063470201)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063470201 NPI number — MAUI DIAGNOSTIC IMAGING LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MAUI DIAGNOSTIC IMAGING 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:
1063470201
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1300
Provider Second Line Business Mailing Address:
MAIL CODE 61059
Provider Business Mailing Address City Name:
HONOLULU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96807-1300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-635-4411
Provider Business Mailing Address Fax Number:
425-637-4646

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
53 PUUNENE AVE
Provider Second Line Business Practice Location Address:
STE 115
Provider Business Practice Location Address City Name:
KAHULUI
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96732
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-877-6402
Provider Business Practice Location Address Fax Number:
808-871-5587
Provider Enumeration Date:
05/03/2006

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:
425-637-3378

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0200997 . This is a "DEPT OF L & I" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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