Blue Lion Medical

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

PA9101635 Issued in FL

Legal business name

BLUE LION MEDICAL

Practice address

3600 Washington St
Hollywood, FL 33021-8216

Phone

(954) 773-5744

Fax

(954) 962-1994

NPI assigned

Nov 23, 2010

Last updated

Nov 23, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jeana Marie Heinz, PA-C

Title

Managing Director

Phone

(954) 557-4140

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1290470400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1290470400000",
    "number": "1790087856",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 814479",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330814479",
            "telephone_number": "954-773-5744",
            "fax_number": "954-962-1994"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3600 WASHINGTON ST",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330218216",
            "telephone_number": "954-773-5744",
            "fax_number": "954-962-1994"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE LION MEDICAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-23",
        "last_updated": "2010-11-23",
        "status": "A",
        "authorized_official_last_name": "HEINZ",
        "authorized_official_first_name": "JEANA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "MANAGING DIRECTOR",
        "authorized_official_telephone_number": "954-557-4140",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "FL",
            "license": "PA9101635",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elazar Abraham Bloom, LMFT
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• Deborah Blum

• Surgical Physician Assistant in Hollywood, FL
• Providers in Hollywood, FL by specialty
• Surgical Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2010; 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.