Healthy Miles LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

HEALTHY MILES LLC

Practice address

4142 Shoreline Dr
Spring Park, MN 55384-9629

Phone

(866) 305-0622

NPI assigned

Sep 21, 2022

Last updated

Sep 21, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Damon Kenton

Title

Owner

Phone

(612) 242-9517

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1663718400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663718400000",
    "number": "1831812239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4142 SHORELINE DR",
            "city": "SPRING PARK",
            "state": "MN",
            "postal_code": "553849629"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4142 SHORELINE DR",
            "city": "SPRING PARK",
            "state": "MN",
            "postal_code": "553849629",
            "telephone_number": "866-305-0622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTHY MILES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-21",
        "last_updated": "2022-09-21",
        "certification_date": "2022-09-21",
        "status": "A",
        "authorized_official_last_name": "KENTON",
        "authorized_official_first_name": "DAMON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "612-242-9517"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Spring Park, MN
• Providers in Spring Park, MN by specialty
• Internal Medicine Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2022; 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.