# BLUE LION MEDICAL

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790087856
- **Authorized official:** JEANA MARIE HEINZ PA-C (MANAGING DIRECTOR)
- **Authorized official phone:** (954) 557-4140

## Contact information

- **Practice address:** 3600 WASHINGTON ST, HOLLYWOOD, FL 33021-8216
- **Practice address phone:** (954) 773-5744
- **Practice address fax:** (954) 962-1994
- **Mailing address:** PO BOX 814479, HOLLYWOOD, FL 33081-4479
- **Mailing address phone:** (954) 773-5744
- **Mailing address fax:** (954) 962-1994

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363AS0400X | Surgical Physician Assistant | PA9101635 | FL | Yes |

## Other

- **Enumeration date:** 11/23/2010
- **Last updated:** 11/23/2010