1689007189 NPI number — HEALTHFAIR PLUS PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689007189 NPI number — HEALTHFAIR PLUS PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTHFAIR PLUS PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689007189
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/15/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
608 SW 8TH ST
Provider Second Line Business Practice Location Address:
6TH FLOOR
Provider Business Practice Location Address City Name:
BENTONVILLE
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72712-6207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-672-0919
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/20/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
EKBATANI
Authorized Official First Name:
RAY
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF ADMINISTRATIVE OFFICER
Authorized Official Telephone Number:
407-620-7232

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)