1174679443 NPI number — HAWAII RADIOLOGIC ASSOCIATES, LTD.

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 1174679443 NPI number — HAWAII RADIOLOGIC ASSOCIATES, LTD.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HAWAII RADIOLOGIC ASSOCIATES, LTD.
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:
1174679443
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/02/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
688 KINOOLE ST.
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
HILO
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96720
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-935-1825
Provider Business Mailing Address Fax Number:
808-935-8362

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
670 PONAHAWAI ST.
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
HILO
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-933-2540
Provider Business Practice Location Address Fax Number:
808-961-9236
Provider Enumeration Date:
01/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
AGUIAR
Authorized Official First Name:
STACEY
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
808-935-1825

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: 0012674 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".




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