Provider Demographics
NPI:1942638689
Name:HONOLULU PSYCHIATRIC SERCIES LLC
Entity Type:Organization
Organization Name:HONOLULU PSYCHIATRIC SERCIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-388-4969
Mailing Address - Street 1:1188 BISHOP ST STE 1102
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-3304
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1188 BISHOP ST STE 1102
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-3304
Practice Address - Country:US
Practice Address - Phone:808-388-4969
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-16
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI159982084P0800X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI00D0302036Medicaid
HI77004Medicaid
HI12101Medicaid
HI686868Medicaid
HI691232Medicaid
HI724246Medicaid
00D0302036Medicare PIN
HI00D0302036Medicaid
HI77500 77501Medicare PIN
7700077003Medicare PIN
691232Medicare PIN
HI12101Medicaid
GC729AMedicare PIN