NPIMap

Organization Active NPI

Maui Diagnostic Imaging LLC

  • Diagnostic Radiology Physician
  • Kahului, HI
National Provider Identifier
1063470201
Registry record updated Jan 29, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
MAUI DIAGNOSTIC IMAGING LLC
Practice address
53 Puunene Ave
Ste 115
Kahului, HI 96732
Phone
(808) 877-6402
Fax
(808) 871-5587
NPI assigned
May 3, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 29, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Scott B Halliday
Title
Member of Owner
Phone
(425) 637-3378

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2085R0202X Primary

Addresses

Primary practice location

53 Puunene Ave
Ste 115
Kahului, HI 96732

Mailing address

PO Box 1300
Mail Code 61059
Honolulu, HI 96807-1300
Phone (425) 635-4411

Other identifiers 1

IdentifierTypeStateIssuer
0200997OtherWADEPT OF L & I

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in HI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040611000270 HI Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 8921081035 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Kihei, HI
O20040611000994 HI Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 8921081035 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Kahului, HI

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1146614400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1201564800000",
    "number": "1063470201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1300",
            "address_2": "MAIL CODE 61059",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968071300",
            "telephone_number": "425-635-4411",
            "fax_number": "425-637-4646"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "53 PUUNENE AVE",
            "address_2": "STE 115",
            "city": "KAHULUI",
            "state": "HI",
            "postal_code": "96732",
            "telephone_number": "808-877-6402",
            "fax_number": "808-871-5587"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAUI DIAGNOSTIC IMAGING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-03",
        "last_updated": "2008-01-29",
        "status": "A",
        "authorized_official_last_name": "HALLIDAY",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "MEMBER OF OWNER",
        "authorized_official_telephone_number": "425-637-3378"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPT OF L & I",
            "identifier": "0200997",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kahului, HI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.