Basic Information
| Provider Information | |||||||||
| NPI: | 1265490338 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ST FRANCIS IMAGING LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ISLAND IMAGING CENTER LLC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1300 | ||||||||
| Address2: | #60179 | ||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 96807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8003629772 | ||||||||
| FaxNumber: | 4256374646 | ||||||||
| Practice Location | |||||||||
| Address1: | 2230 LILIHA STREET | ||||||||
| Address2: | |||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 96817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8085476311 | ||||||||
| FaxNumber: | 8085476053 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | HALLIDAY | ||||||||
| AuthorizedOfficialFirstName: | SCOTT | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | MEMBER OF OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8003629772 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Radiology |
ID Information
| ID | Type | State | Issuer | Description | 0000223727 | 01 | MEDICAID HMSA QUEST | OTHER | 51682 | 01 | MEDICARE CLASS | OTHER | P00155239 | 01 | RAILROAD MEDICARE | OTHER | 0000223727 | 01 | HMSA 65C PLUS | OTHER | 25073301 | 01 | MEDICAID CLASS | OTHER | 0000223727 | 01 | HI | HMSA | OTHER | Z1520 | 01 | HI | MDX | OTHER | Z1520 | 01 | QUEENS MDX | OTHER | 25073301 | 05 | HI | MEDICAID |