Blue Lake Medical Center, Inc.

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

BLUE LAKE MEDICAL CENTER, INC.

Practice address

2360 W 68TH St Ste 122
Hialeah, FL 33016-5502

Phone

(305) 200-5705

Fax

(305) 392-1217

NPI assigned

Mar 7, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jorge Garcia

Title

Credentialing Director

Phone

(305) 606-0337

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1615075200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1615075200000",
    "number": "1114512670",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2360 W 68TH ST STE 122",
            "city": "HIALEAH",
            "state": "FL",
            "postal_code": "330165502",
            "telephone_number": "305-200-5705",
            "fax_number": "305-392-1217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2360 W 68TH ST STE 122",
            "city": "HIALEAH",
            "state": "FL",
            "postal_code": "330165502",
            "telephone_number": "305-200-5705",
            "fax_number": "305-392-1217"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE LAKE MEDICAL CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-07",
        "last_updated": "2021-03-07",
        "certification_date": "2021-03-07",
        "status": "A",
        "authorized_official_last_name": "GARCIA",
        "authorized_official_first_name": "JORGE",
        "authorized_official_title_or_position": "CREDENTIALING DIRECTOR",
        "authorized_official_telephone_number": "305-606-0337"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Blue Heaven Rehabilitation Inc
• Blue Heaven Rehabilitation Inc
• Blue Horizon Interventional Pulmonary Corp
• Blue Horizon Rehab Medical, Corp.
• Blue Lagoon Medical Center Inc
• Blue Leaf Med Supplies Inc
• Blue Paradise ABA LLC
• Blue Paradise Medical Center LLC
• Blue Paradise Medical Center LLC
• Blue Planets Behavior Corp

• Clinic/Center in Hialeah, FL
• Providers in Hialeah, FL by specialty
• Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.