Provider Demographics
NPI:1902802234
Name:HAWAII PET IMAGING, LLC.
Entity Type:Organization
Organization Name:HAWAII PET IMAGING, LLC.
Other - Org Name:HAWAII ADVANCED IMAGING INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
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:STE. 202
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105
Mailing Address - Country:US
Mailing Address - Phone:206-272-3580
Mailing Address - Fax:206-272-3588
Practice Address - Street 1:1401 S BERETANIA ST
Practice Address - Street 2:STE. 107
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-1870
Practice Address - Country:US
Practice Address - Phone:808-590-1504
Practice Address - Fax:808-591-1506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-22
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI10667130247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI234351OtherHMSA PIN
HI52788001Medicaid
HIZ1625OtherQUEENS/MDX PIN
HI527880Medicaid
HIH102128Medicare PIN
HI54537Medicare PIN