Provider Demographics
NPI:1972914117
Name:HAWAII PET IMAGING LLC
Entity type:Organization
Organization Name:HAWAII PET IMAGING LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:B
Authorized Official - Last Name:HALLIDAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-272-3580
Mailing Address - Street 1:5001 25TH AVE NE
Mailing Address - Street 2:202
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-5661
Mailing Address - Country:US
Mailing Address - Phone:206-272-3580
Mailing Address - Fax:206-272-3588
Practice Address - Street 1:98-1247 KAAHUMANU ST
Practice Address - Street 2:SUITE 320
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-5311
Practice Address - Country:US
Practice Address - Phone:808-591-1504
Practice Address - Fax:808-591-1506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-09
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIW20190908247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistGroup - Single Specialty