Provider Demographics
NPI:1174679443
Name:HAWAII RADIOLOGIC ASSOCIATES, LTD
Entity Type:Organization
Organization Name:HAWAII RADIOLOGIC ASSOCIATES, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMACHO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-663-7393
Mailing Address - Street 1:688 KINOOLE ST.
Mailing Address - Street 2:STE 103
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-3868
Mailing Address - Country:US
Mailing Address - Phone:808-935-1825
Mailing Address - Fax:903-663-7394
Practice Address - Street 1:670 PONAHAWAI ST
Practice Address - Street 2:STE 110
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2660
Practice Address - Country:US
Practice Address - Phone:808-933-2540
Practice Address - Fax:903-663-7394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0012674Medicaid
HIH0000WCCBGMedicare PIN