Provider Demographics
NPI:1083016380
Name:WEST OAHU RADIOLOGY LLC
Entity Type:Organization
Organization Name:WEST OAHU RADIOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-591-1504
Mailing Address - Street 1:94-229 WAIPAHU DEPOT ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-3031
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:94-229 WAIPAHU DEPOT ST
Practice Address - Street 2:SUITE 101
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-3031
Practice Address - Country:US
Practice Address - Phone:808-591-1504
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-18
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD42022085N0904X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear RadiologyGroup - Single Specialty