Provider Demographics
NPI:1184169393
Name:HAPPY HEARTS SURGICAL ASSIST LLC
Entity type:Organization
Organization Name:HAPPY HEARTS SURGICAL ASSIST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:KENICK
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:954-298-1218
Mailing Address - Street 1:4023 PALM PL
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33331-5036
Mailing Address - Country:US
Mailing Address - Phone:954-298-1218
Mailing Address - Fax:954-917-6817
Practice Address - Street 1:4023 PALM PL
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33331-5036
Practice Address - Country:US
Practice Address - Phone:954-298-1218
Practice Address - Fax:954-917-6817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-23
Last Update Date:2016-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA3593363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty