MEDICARE: HEALTHFAIR PLUS SC PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207W00000X	Ophthalmology Physician
2	2085R0202X	Diagnostic Radiology Physician
3	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1558819169
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHFAIR PLUS SC PC

Provider Business Mailing Address
First Line	:	1030 SPRING VILLAS PT STE 3000
Second Line	:
City	:	WINTER SPRINGS
State	:	FL
Zip	:	32708-6621
Country	:	US
Telephone Number	:	407-672-0919
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 TRADERS CROSS
Second Line	:	1ST FLOOR
City	:	BLUFFTON
State	:	SC
Zip	:	29909-4637
Country	:	US
Telephone Number	:	407-672-0919
Fax Number	:

Authorized Official
Title or Position	:	CHIEF ADMIN OFFICER
Name	:	RAY EKBATANI
Credential	:
Telephone Number	:	407-672-0919

Provider Enumeration Date	:	09/13/2016
Last Update Date	:	09/13/2016

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