Provider Demographics
NPI:1770994014
Name:CARDIOVASCULAR SPECIALISTS OF HAWAII, LLC
Entity type:Organization
Organization Name:CARDIOVASCULAR SPECIALISTS OF HAWAII, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:RVT
Authorized Official - Phone:808-250-3216
Mailing Address - Street 1:99-128 AIEA HEIGHTS DR STE 206
Mailing Address - Street 2:
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-3932
Mailing Address - Country:US
Mailing Address - Phone:808-250-3216
Mailing Address - Fax:808-487-6906
Practice Address - Street 1:99-128 AIEA HEIGHTS DR STE 206
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-3932
Practice Address - Country:US
Practice Address - Phone:808-250-3216
Practice Address - Fax:808-487-6906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-08
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center