BLACKSHEEP MEDICAL LLC (NPI# 1992134712) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1992134712 |
| Entity Type | Organization |
| Organization Name | BLACKSHEEP MEDICAL LLC |
| Practice Address |
1425 Hand Ave Suite L Ormond Beach FL 32174-1135 |
| Mailing Address |
5626 Oberlin Dr Suite 110 San Diego CA 92121-1705 |
| Practice Telephone | 3862563977 |
| Enumeration Date | 2013-11-02 |
| Last Update Date | 2013-11-02 |
| Authorized Official Name | KENNY HEINE (VP OF OPERATIONS) |
| Authorized Official Telephone | 8589641506 |
| Is Organization Subpart | Y |
| Parent Organization Name | MEDVANTX, INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332900000X | Non-Pharmacy Dispensing Site | OS8215 | FL | Suppliers |
| Street Address |
1425 HAND AVE SUITE L |
| City | ORMOND BEACH |
| State | FL |
| Zip Code | 32174-1135 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760474399 | Richard A Jablonski | Ophthalmology | 1425 Hand Ave, Ste A, Ormond Beach, FL 32174-1135 | 2005-08-19 |
| 1558814228 | Brittany Forster | Physical Therapist | 1425 Hand Ave, Suite H, Ormond Beach, FL 32174-1135 | 2016-07-29 |
| 1124401351 | Tammy Kay Kirby | Nurse Practitioner | 1425 Hand Ave, Ormond Beach, FL 32174-1135 | 2015-07-07 |
| 1972928091 | Jamie L Morris | Physical Therapist | 1425 Hand Ave, Suite H, Ormond Beach, FL 32174-1135 | 2014-02-26 |
| 1770913360 | Blacksheep Medical | Clinic/Center | 1425 Hand Ave, Suite L, Ormond Beach, FL 32174-1135 | 2013-11-18 |
| 1164751632 | Jennifer Lynn Young | Physical Therapist | 1425 Hand Ave, Suite H, Ormond Beach, FL 32174-1135 | 2009-12-13 |
| 1528219920 | Nannine Knoerzer Dahlen | Physical Therapist | 1425 Hand Ave, Ormond Beach, FL 32174-1135 | 2008-10-02 |
| 1871759266 | Oana Mierloi Dds, Pa | Dentist | 1425 Hand Ave, Suite J, Ormond Beach, FL 32174-1135 | 2008-08-05 |
| 1801072517 | Barr & Associates Physical Therapy,llc | Clinic/Center | 1425 Hand Ave, Suite H, Ormond Beach, FL 32174 | 2008-01-11 |
| 1689863656 | Deanna K Springer M D P A | Internal Medicine | 1425 Hand Ave, Suite E, Ormond Beach, FL 32174-1135 | 2007-10-16 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215574991 | Case Vision Pa | Optometrist | Eye Savers, 1474 W. Granada Blvd. #470, Ormond Beach, FL 32174 | 2019-12-02 |
| 1235797143 | Galia Leilani Medrano Ramirez | Dentist | 1274 W. Granada Blvd, Ormond Beach, FL 32174 | 2019-06-05 |
| 1295299220 | Jessica Johnson Hills | Nurse Practitioner | 1400 Hand Ave Ste K, Ormond Beach, FL 32174 | 2019-01-23 |
| 1437507043 | Natasha Jairam | Family Medicine | Adventhealth Medical Group Family Medicine, 400 Clyde Morris Blvd Ste A, Ormond Beach, FL 32174 | 2016-05-25 |
| 1871956540 | Lisa Anne Parissi | Chiropractor | 157 Kimberly Drive, Ormond Beach, FL 32174 | 2016-03-31 |
| 1023477940 | Ambassador Health Services, Inc | In Home Supportive Care | 136 N Orchard St Ste 1, Ormond Beach, FL 32174 | 2016-02-19 |
| 1619341518 | Maria Rogers | Optometrist | 9 Abacus Ave, Ormond Beach, FL 32174 | 2015-11-16 |
| 1285003830 | Sydney Kalin Neuhardt | Nurse Practitioner | 725 W. Granada Blvd. Ste 1, Ormond Beach, FL 32174 | 2015-09-24 |
| 1194107821 | Jerusha Thacker | Case Manager/Care Coordinator | 259 Bill France Blvd. Ste 200, Daytona Beach, FL 32174 | 2015-06-18 |
| 1730569971 | Daniel Joseph Lapolla | Physical Therapy Assistant | 1275 Granada Blvd, Suite 4b2, Ormond Beach, FL 32174 | 2015-06-03 |
| Find all providers in zip 32174 | ||||
| Taxonomy Code | 332900000X |
| Grouping | Suppliers |
| Classification | Non-Pharmacy Dispensing Site |
| A site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.) |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
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| 1437765823 | South Miami Hospital, Inc | Non-Pharmacy Dispensing Site | 1228 S Pine Island Rd Ste 110, Plantation, FL 33324-4402 | 2020-09-21 |
| 1407460223 | Daisy Lomadilla Boyer | Non-Pharmacy Dispensing Site | 11703 Holly Creek Dr, Riverview, FL 33569-3356 | 2020-08-31 |
| 1760091078 | West Kendall Baptist Hospital, Inc. | Non-Pharmacy Dispensing Site | 14591 Sw 26th St, Miami, FL 33175-8038 | 2020-07-23 |
| 1821615436 | South Miami Hospital, Inc | Non-Pharmacy Dispensing Site | 8400 Nw 53rd St Ste F106, Doral, FL 33166-4519 | 2020-06-30 |
| 1295358422 | Ezze Pharma LLC | Non-Pharmacy Dispensing Site | 3105 Nw 107th Ave Ste 400, Doral, FL 33172-2215 | 2020-05-21 |
| 1871115436 | Kempcare Inc. | Non-Pharmacy Dispensing Site | 840 Us Highway 1 Ste 435c, N Palm Beach, FL 33408-3829 | 2020-05-17 |
| 1427670595 | Orlando Dermatology Clinic, LLC | Non-Pharmacy Dispensing Site | 3261 Us Highway 441/27 Ste F1, Fruitland Park, FL 34731-4495 | 2020-05-12 |
| 1518593177 | Dedicated Senior Medical Center of Florida, LLC | Non-Pharmacy Dispensing Site | 2724 N Hiawassee Rd Ste 100, Orlando, FL 32818-3008 | 2020-03-16 |
| Find all providers with the same taxonomy | ||||
| City | ORMOND BEACH |
| Zip Code | 32174 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.