Provider Demographics
NPI:1346975752
Name:HAXMON MEDICAL SERVICES P LLC LLC
Entity Type:Organization
Organization Name:HAXMON MEDICAL SERVICES P LLC LLC
Other - Org Name:HAXMON MEDICAL SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:CMO
Authorized Official - Prefix:DR
Authorized Official - First Name:BLEDAR
Authorized Official - Middle Name:
Authorized Official - Last Name:HAXHIU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-651-7275
Mailing Address - Street 1:2511 N HIATUS RD # 166
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33026-1301
Mailing Address - Country:US
Mailing Address - Phone:215-651-7275
Mailing Address - Fax:888-818-1230
Practice Address - Street 1:1201 N 37TH AVE STE 100
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-5414
Practice Address - Country:US
Practice Address - Phone:305-562-8090
Practice Address - Fax:888-818-1230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-19
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty