MEDICARE: HEALTHY HEART DIAGNOSTICS, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1861631079
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHY HEART DIAGNOSTICS, LLC

Provider Business Mailing Address
First Line	:	5030 CHAMPION BLVD
Second Line	:	G6286
City	:	BOCA RATON
State	:	FL
Zip	:	33496-2473
Country	:	US
Telephone Number	:	561-703-1166
Fax Number	:

Provider Business Practice Location Address
First Line	:	5030 CHAMPION BLVD
Second Line	:	G6286
City	:	BOCA RATON
State	:	FL
Zip	:	33496-2473
Country	:	US
Telephone Number	:	561-703-1166
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. JAMIE SUE NIX
Credential	:
Telephone Number	:	561-703-1166

Provider Enumeration Date	:	02/11/2009
Last Update Date	:	02/11/2009

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