Provider Demographics
NPI:1144487380
Name:MAUI DIAGNOSTIC IMAGING LLC
Entity type:Organization
Organization Name:MAUI DIAGNOSTIC IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:B
Authorized Official - Last Name:HALLIDAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-637-3378
Mailing Address - Street 1:11100 NE 8TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-4465
Mailing Address - Country:US
Mailing Address - Phone:425-637-3378
Mailing Address - Fax:425-637-7535
Practice Address - Street 1:425 KOLOA ST
Practice Address - Street 2:# 102
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-2486
Practice Address - Country:US
Practice Address - Phone:808-873-9551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-16
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile