BLUE LION MEDICAL (NPI# 1790087856) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790087856 |
| Entity Type | Organization |
| Organization Name | BLUE LION MEDICAL |
| Practice Address |
3600 Washington St Hollywood FL 33021-8216 |
| Mailing Address |
Po Box 814479 Hollywood FL 33081-4479 |
| Practice Telephone | 9547735744 |
| Practice Fax Number | 9549621994 |
| Mailing Telephone | 9547735744 |
| Mailing Fax Number | 9549621994 |
| Enumeration Date | 2010-11-23 |
| Last Update Date | 2010-11-23 |
| Authorized Official Name | JEANA MARIE HEINZ (MANAGING DIRECTOR) |
| Authorized Official Telephone | 9545574140 |
| Authorized Official Credential | PA-C |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
PA9101635 | FL | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
3600 WASHINGTON ST |
| City | HOLLYWOOD |
| State | FL |
| Zip Code | 33021-8216 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306831359 | Sterling Emergency Services of Florida Pa | Emergency Medicine | 3600 Washington St, Hollywood, FL 33021-8216 | 2005-09-15 |
| 1285244772 | Franco A Dickson | Pharmacist | 3600 Washington St, Hollywood, FL 33021-8216 | 2020-08-09 |
| 1306496773 | Richie Onwuchekwa Uba | Pharmacist | 3600 Washington St, Hollywood, FL 33021-8216 | 2019-09-17 |
| 1215499942 | Matthew Voelker | Student in an Organized Health Care Education/Training Program | 3600 Washington St, Hollywood, FL 33021-8216 | 2019-04-02 |
| 1790246171 | Andres Eduardo Gutierrez | Student in an Organized Health Care Education/Training Program | 3600 Washington St, Hollywood, FL 33021-8216 | 2019-03-27 |
| 1639630312 | Uday Mathur | Student in an Organized Health Care Education/Training Program | 3600 Washington St, Hollywood, FL 33021-8216 | 2019-03-26 |
| 1548754989 | Abhinav Mohan | Student in an Organized Health Care Education/Training Program | 3600 Washington St, Hollywood, FL 33021-8216 | 2018-06-19 |
| 1427548346 | Errol Scarlett | Student in an Organized Health Care Education/Training Program | 3600 Washington St, Hollywood, FL 33021-8216 | 2018-05-16 |
| 1326553322 | Supti Sarkar | Pharmacist | 3600 Washington St, Hollywood, FL 33021-8216 | 2017-12-12 |
| 1477973709 | Rita Hudec | Emergency Medicine | 3600 Washington St, Hollywood, FL 33021-8216 | 2014-04-25 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548893894 | Seminole Tribe of Florida Health Department | Pharmacy | 111 W. Coral Way, Hollywood, FL 33021 | 2020-02-14 |
| 1437714086 | Emilia Roxana Gucciardo | Physician Assistant | 4510 Sheridan Street, Attn: William Pepe, Hollywood, FL 33021 | 2019-05-08 |
| 1649763673 | Sabrina Shoba Mathura | Behavior Technician | 4400 Madison St, Hollywood, FL 33021 | 2018-06-13 |
| 1558850149 | South Broward Hospital District | Pediatrics | 105 Joe Dimaggio Dr, Pediatric Heart Station, Hollywood, FL 33021 | 2018-05-09 |
| 1942798368 | Kyndra Monique Liburd | Student in an Organized Health Care Education/Training Program | Attn: Pediatric Residency Program, 1005 Joe Dimaggio Drive, Hollywood, FL 33021 | 2018-05-01 |
| 1992292106 | Madeleine Mariela Reyes | Nurse Practitioner | 5010 Hollywood Boulevard #100-b, Hollywood, FL 33021 | 2018-04-13 |
| 1487168233 | Gynecologic Oncology & Urogynecology | Obstetrics & Gynecology | 1150 N 35th Ave Ste 670, Hollywood, FL 33021 | 2017-11-30 |
| 1245743012 | Healix Healthcare Services, LLC | Obstetrics & Gynecology | 3990 Sheridan St Ste 207, Hollywood, FL 33021 | 2017-11-14 |
| 1093233587 | Benjamin Laborde | Physical Therapy Assistant | 4200 Washington Street, Hollywood, FL 33021 | 2017-09-05 |
| 1477079358 | Tt Trans, LLC | Non-emergency Medical Transport (VAN) | 3550 Washington Street, 502, Hollywood, FL 33021 | 2017-08-22 |
| Find all providers in zip 33021 | ||||
| Taxonomy Code | 363AS0400X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Surgical Technologist |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306120746 | Odalis Castellon | Physician Assistant | 3449 Johnson Street, Hollywood, FL 33021 | 2011-10-04 |
| 1700992559 | Magdalena Marie Gonzalez | Physician Assistant | 1150 N 35th Ave Ste 600, Hollywood, FL 33021 | 2006-08-22 |
| 1003381526 | Andrea Lobue | Physician Assistant | 4700 Sheridan St Ste H, Hollywood, FL 33021-3416 | 2018-10-11 |
| 1699160705 | Melissa Lee Chapman-leccesse | Physician Assistant | 1150 N 35th Ave, Suite 345, Hollywood, FL 33021-5424 | 2015-04-06 |
| 1225420441 | Shari Selesky | Physician Assistant | 1150 N 35th Avenue, Ste 600, Hollywood, FL 33021 | 2015-02-25 |
| 1831418458 | Armaal Rashard Hunter | Physician Assistant | 1150 N 35th Avenue, Suite 440, Hollywood, FL 33021-5430 | 2010-05-21 |
| 1467538462 | Krystal M Buckland | Physician Assistant | 1150 N 35th Ave, Ste 345, Hollywood, FL 33021 | 2006-10-31 |
| 1518052885 | Christina Marie Callan | Physician Assistant | 1150 N 35th Ave, Suite 345, Hollywood, FL 33021 | 2006-10-04 |
| 1245346063 | Krysten Riordan | Physician Assistant | 4440 Sheridan St, Hollywood, FL 33021-3535 | 2006-08-22 |
| 1023020310 | Louis Carlisle | Physician Assistant | 1150 N 35th Ave Ste 440, Hollywood, FL 33021-5430 | 2006-08-13 |
| Find all providers in HOLLYWOOD | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.