1265490338 NPI number — ST FRANCIS IMAGING LLC

Table of content: (NPI 1265490338)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265490338 NPI number — ST FRANCIS IMAGING LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST FRANCIS 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:
ISLAND IMAGING CENTER LLC
Provider Other Organization Name Type Code:
3
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:
1265490338
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 1300
Provider Second Line Business Mailing Address:
#60179
Provider Business Mailing Address City Name:
HONOLULU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96807
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:
2230 LILIHA STREET
Provider Second Line Business Practice Location Address:
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:
808-547-6311
Provider Business Practice Location Address Fax Number:
808-547-6053
Provider Enumeration Date:
05/01/2006

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: 261QR0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0000223727 . This is a "MEDICAID HMSA QUEST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 51682 . This is a "MEDICARE CLASS" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00155239 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0000223727 . This is a "HMSA 65C PLUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 25073301 . This is a "MEDICAID CLASS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0000223727 . This is a "HMSA" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: Z1520 . This is a "MDX" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: Z1520 . This is a "QUEENS MDX" identifier . This identifiers is of the category "OTHER".
  • Identifier: 25073301 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".




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