Indiblu Management LLC

Primary specialty

Exclusive Provider OrganizationTaxonomy code 302F00000X

Legal business name

INDIBLU MANAGEMENT LLC

Practice address

1425 SW 110TH Way
Davie, FL 33324-7185

Phone

(954) 445-9806

Fax

(954) 337-8265

NPI assigned

Mar 16, 2023

Organization subpart

No

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

Authorized official

Name

Lucinda Blunt

Title

Executive Director

Phone

(754) 224-9333

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1678924800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678924800000",
    "number": "1891496667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1425 SW 110TH WAY",
            "city": "DAVIE",
            "state": "FL",
            "postal_code": "333247185",
            "telephone_number": "954-445-9806",
            "fax_number": "954-337-8265"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1425 SW 110TH WAY",
            "city": "DAVIE",
            "state": "FL",
            "postal_code": "333247185",
            "telephone_number": "954-445-9806",
            "fax_number": "954-337-8265"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIBLU MANAGEMENT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-16",
        "last_updated": "2023-03-16",
        "certification_date": "2023-03-16",
        "status": "A",
        "authorized_official_last_name": "BLUNT",
        "authorized_official_first_name": "LUCINDA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "754-224-9333"
    },
    "taxonomies": [
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Exclusive Provider Organization in Davie, FL
• Providers in Davie, FL by specialty
• Exclusive Provider Organization in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2023; 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.