Basic Information
| Provider Information | |||||||||
| NPI: | 1821054412 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HAWAII ENDOSCOPY CENTER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 29960 | ||||||||
| Address2: | |||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 96820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8003629772 | ||||||||
| FaxNumber: | 4256374646 | ||||||||
| Practice Location | |||||||||
| Address1: | 2226 LILIHA STREET | ||||||||
| Address2: | SUITE 407 | ||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 96817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8085315823 | ||||||||
| FaxNumber: | 8085315819 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | HALLIDAY | ||||||||
| AuthorizedOfficialFirstName: | SCOTT | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | MEMBER OF OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8003629772 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
ID Information
| ID | Type | State | Issuer | Description | 0000232165 | 01 | MEDICAID HMSA QUEST | OTHER | 52073501 | 05 | HI | MEDICAID | 52073501 | 01 | MEDICARE CLASS | OTHER | 54102 | 01 | MEDICARE CLASS | OTHER | Z1617 | 01 | HI | MDX | OTHER | 0000232165 | 01 | HMSA 65C PLUS | OTHER | Z1617 | 01 | QUEENS MDS | OTHER | 0000232165 | 01 | HMSA | OTHER | 52073501 | 01 | MEDICAID HAWAII | OTHER |