Provider Demographics
NPI:1891827408
Name:HS1 MEDICAL MANAGEMENT INC
Entity Type:Organization
Organization Name:HS1 MEDICAL MANAGEMENT INC
Other - Org Name:HEALTH SYSTEM ONE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEAHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-422-3672
Mailing Address - Street 1:2001 S ANDREWS AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-3429
Mailing Address - Country:US
Mailing Address - Phone:800-422-3672
Mailing Address - Fax:305-620-5876
Practice Address - Street 1:2001 S ANDREWS AVE
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-3429
Practice Address - Country:US
Practice Address - Phone:800-422-3672
Practice Address - Fax:305-620-5876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCOMPANY CODE 168041OtherPRIVATE REVIEW AGENT
GATPA 44185OtherTPA LICENSE
ILTPA20070107OtherTPA
FL992366700Medicaid
FLCERT # 1702,REG #806OtherPRIVATE REVIEW AGENT
TXCERT 5358OtherPRIVATE REVIEW AGENT
GATPA 44185OtherTPA LICENSE