Provider Demographics
NPI:1861457376
Name:ISLAND CARDIAC CENTERS LLC
Entity type:Organization
Organization Name:ISLAND CARDIAC CENTERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WENDELL
Authorized Official - Middle Name:
Authorized Official - Last Name:PANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-782-7599
Mailing Address - Street 1:PO BOX 1300
Mailing Address - Street 2:MAIL CODE 60157
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96807-1300
Mailing Address - Country:US
Mailing Address - Phone:800-362-9772
Mailing Address - Fax:425-637-4646
Practice Address - Street 1:2230 LILIHA ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-1646
Practice Address - Country:US
Practice Address - Phone:808-585-0887
Practice Address - Fax:808-585-4509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471C1106XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistCardiac-Interventional TechnologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIZ1629OtherMDX
0000235648OtherHMSA 65C PLUS
HI50667801Medicaid
Z1629OtherQUEENS MDX
HI0000235648OtherHMSA
0000235648OtherMEDICAID HMSA QUEST
50667801OtherMEDICAID CLASS
HIZ1629OtherMDX
HI0000235648OtherHMSA
0000235648OtherMEDICAID HMSA QUEST