Provider Demographics
NPI:1871234732
Name:BLUE DIAMOND SURGICAL SPECIALISTS LLC
Entity Type:Organization
Organization Name:BLUE DIAMOND SURGICAL SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLINS-BRENNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-693-9324
Mailing Address - Street 1:1500 N DIXIE HWY STE 300
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-2717
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1500 N DIXIE HWY STE 304
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-2717
Practice Address - Country:US
Practice Address - Phone:561-833-4022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-05
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty