Provider Demographics
NPI:1952177412
Name:HEALTHY BODY LLC
Entity Type:Organization
Organization Name:HEALTHY BODY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:G
Authorized Official - Last Name:IACONO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-952-1539
Mailing Address - Street 1:119 SAUVE ROAD
Mailing Address - Street 2:
Mailing Address - City:RIVER RIDGE
Mailing Address - State:LA
Mailing Address - Zip Code:70123
Mailing Address - Country:US
Mailing Address - Phone:504-952-1539
Mailing Address - Fax:
Practice Address - Street 1:1733 UNIVERSITY AVE STE A
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-4196
Practice Address - Country:US
Practice Address - Phone:504-952-1539
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-27
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083B0002XAllopathic & Osteopathic PhysiciansPreventive MedicineObesity MedicineGroup - Single Specialty
No207RB0002XAllopathic & Osteopathic PhysiciansInternal MedicineObesity Medicine