Provider Demographics
NPI:1154351229
Name:HEALTHY HEART CARE PA
Entity type:Organization
Organization Name:HEALTHY HEART CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:B
Authorized Official - Last Name:CHAPIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:321-728-8400
Mailing Address - Street 1:3830 S HWY A1A
Mailing Address - Street 2:SUITE 4-183
Mailing Address - City:MELBOURNE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32951-3143
Mailing Address - Country:US
Mailing Address - Phone:321-728-8400
Mailing Address - Fax:
Practice Address - Street 1:3830 S HWY A1A
Practice Address - Street 2:SUITE 4-183
Practice Address - City:MELBOURNE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32951-3143
Practice Address - Country:US
Practice Address - Phone:321-728-8400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 0004658207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAD240Medicare PIN
FL82621Medicare ID - Type Unspecified