Healthy Seniors Medical Holdings LLC

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

HEALTHY SENIORS MEDICAL HOLDINGS LLC

Practice address

515 E Las Olas Blvd Ste 120
Ft Lauderdale, FL 33301-4261

Phone

(954) 787-8874

Fax

(561) 584-7505

NPI assigned

Dec 3, 2020

Organization subpart

No

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

Authorized official

Name

Christopher J Pettas

Title

Ceo

Phone

(561) 702-1299

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1606953600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1606953600000",
    "number": "1659976850",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2199 NE 5TH AVE",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334317610",
            "telephone_number": "561-702-1299",
            "fax_number": "561-584-7505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 E LAS OLAS BLVD STE 120",
            "city": "FT LAUDERDALE",
            "state": "FL",
            "postal_code": "333014261",
            "telephone_number": "954-787-8874",
            "fax_number": "561-584-7505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTHY SENIORS MEDICAL HOLDINGS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-03",
        "last_updated": "2020-12-03",
        "certification_date": "2020-12-03",
        "status": "A",
        "authorized_official_last_name": "PETTAS",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "561-702-1299"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Physician in Ft Lauderdale, FL
• Providers in Ft Lauderdale, FL by specialty
• General Practice Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.