Healthcare Provider Details

I. General information

NPI: 1558819169
Provider Name (Legal Business Name): HEALTHFAIR PLUS SC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2016
Last Update Date: 09/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 TRADERS CROSS 1ST FLOOR
BLUFFTON SC
29909-4637
US

IV. Provider business mailing address

1030 SPRING VILLAS PT STE 3000
WINTER SPRINGS FL
32708-6621
US

V. Phone/Fax

Practice location:
  • Phone: 407-672-0919
  • Fax:
Mailing address:
  • Phone: 407-672-0919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: RAY EKBATANI
Title or Position: CHIEF ADMIN OFFICER
Credential:
Phone: 407-672-0919