Blacksheep Medical LLC

Primary specialty

Non-Pharmacy Dispensing SiteTaxonomy code 332900000X

License

OS8215 Issued in FL

Legal business name

BLACKSHEEP MEDICAL LLC

Practice address

1425 Hand Ave
Suite L
Ormond Beach, FL 32174-1135

Phone

(386) 256-3977

NPI assigned

Nov 2, 2013

Last updated

Nov 2, 2013By the provider in NPPES

Organization subpart

Yes

Parent organization

MEDVANTX, INC.As reported in NPPES

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

Authorized official

Name

Kenny Heine

Title

VP of Operations

Phone

(858) 964-1506

Specialties & licenses 1

Addresses

Tax ID family

Black Sheep Medical2 organizations share this tax ID, including this one

Part of

Medvantx Inc

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Blacksheep Medical

  • Health Service Clinic/Center
  • Ormond Beach, FL
  • NPI 1770913360
  NPD tax ID

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

{
    "created_epoch": "1383350400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1383350400000",
    "number": "1992134712",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5626 OBERLIN DR",
            "address_2": "SUITE 110",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921211705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1425 HAND AVE",
            "address_2": "SUITE L",
            "city": "ORMOND BEACH",
            "state": "FL",
            "postal_code": "321741135",
            "telephone_number": "386-256-3977"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLACKSHEEP MEDICAL LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDVANTX, INC.",
        "enumeration_date": "2013-11-02",
        "last_updated": "2013-11-02",
        "status": "A",
        "authorized_official_last_name": "HEINE",
        "authorized_official_first_name": "KENNY",
        "authorized_official_title_or_position": "VP OF OPERATIONS",
        "authorized_official_telephone_number": "858-964-1506"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "FL",
            "license": "OS8215",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bionic Prosthetics and Orthotics Group LLC
• Candies Bishop, QASP-S
• Danniele Bitton
• Harry H Black, MD
• Blacksheep Medical
• Mary Beth Russo Blackwell, LCSW
• BLC Wellington-Sea, LLC (Wellington Place By The Sea)
• Rebecca L Blevins, LMHC, RN
• Bliss Sleep & Respiratory Care, Inc.
• Renae Blondin, LMT

• Non-Pharmacy Dispensing Site in Ormond Beach, FL
• Providers in Ormond Beach, FL by specialty
• Non-Pharmacy Dispensing Site in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2013; 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.