Provider Demographics
NPI:1285337865
Name:HEALTHY MD CLINICAL, LLC F/K/A INDEPENDENT MEDICAL GROUP, LLC
Entity type:Organization
Organization Name:HEALTHY MD CLINICAL, LLC F/K/A INDEPENDENT MEDICAL GROUP, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:VIXAMAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-773-7066
Mailing Address - Street 1:6119 LYONS RD
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-4740
Mailing Address - Country:US
Mailing Address - Phone:407-860-0283
Mailing Address - Fax:
Practice Address - Street 1:411 OFFICE PLAZA DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-2756
Practice Address - Country:US
Practice Address - Phone:800-773-7066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-23
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty