NPIMap

Organization Active NPI

Memorial Medical Group of South Florida, LLC

Doing business as Memorial Mental Health Of South Florida

  • Physician Assistant
  • Hollywood, FL
National Provider Identifier
1336806801
Registry record updated Nov 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Legal business name
MEMORIAL MEDICAL GROUP OF SOUTH FLORIDA, LLC
Doing business as
Memorial Mental Health Of South Florida
Practice address
4000 Hollywood Blvd Ste 555S
Hollywood, FL 33021-6853
Phone
(754) 273-0885
Fax
(833) 955-3596
NPI assigned
Nov 19, 2021
Last updated
Nov 19, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 19, 2021

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

Authorized official

Name
Ms. Lisa B Marshall, DMSC, PACNPI 1225398852
Title
Medical Director
Phone
(754) 273-0885

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician AssistantGroup: 193400000X SINGLE SPECIALTY GROUP 363A00000X Primary

Addresses

Primary practice location

4000 Hollywood Blvd Ste 555S
Hollywood, FL 33021-6853

Mailing address

16000 Pines Boulevard
#822503
Pembroke Pines, FL 33082-2503
Phone (754) 273-0885

Other names 1

  • Memorial Mental Health Of South Florida Doing business as

National Provider Directory

National Provider Directory

Locations

16000 Pines Blvd
Unit 822503
Pembroke Pines, FL 33082

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1637280000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1637280000000",
    "number": "1336806801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16000 PINES BOULEVARD",
            "address_2": "#822503",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330822503",
            "telephone_number": "754-273-0885",
            "fax_number": "754-240-7841"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4000 HOLLYWOOD BLVD STE 555S",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330216853",
            "telephone_number": "754-273-0885",
            "fax_number": "833-955-3596"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEMORIAL MEDICAL GROUP OF SOUTH FLORIDA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-19",
        "last_updated": "2021-11-19",
        "certification_date": "2020-08-06",
        "status": "A",
        "authorized_official_last_name": "MARSHALL",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "754-273-0885",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "DMSC, PAC"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Memorial Mental Health Of South Florida",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hollywood, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 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.