Provider Demographics
NPI:1902911571
Name:ACCUIMAGING PEARLRIDGE, LLC
Entity Type:Organization
Organization Name:ACCUIMAGING PEARLRIDGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:MATWICHYNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-748-4771
Mailing Address - Street 1:500 ALA MOANA BLVD
Mailing Address - Street 2:TOWER 4, SUITE 510
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-4920
Mailing Address - Country:US
Mailing Address - Phone:808-748-4080
Mailing Address - Fax:808-748-4791
Practice Address - Street 1:98-1005 MOANALUA RD
Practice Address - Street 2:UNIT 817
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4777
Practice Address - Country:US
Practice Address - Phone:808-748-4080
Practice Address - Fax:808-748-4791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIW95635412-012085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIH102987Medicare PIN