Provider Demographics
NPI:1104513951
Name:BLUE CIRCLE HEALTH, INC.
Entity type:Organization
Organization Name:BLUE CIRCLE HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LUCESITA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCAMMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-213-2918
Mailing Address - Street 1:68 HARRISON AVE #605
Mailing Address - Street 2:PMB 62564
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111
Mailing Address - Country:US
Mailing Address - Phone:888-404-4813
Mailing Address - Fax:888-675-4061
Practice Address - Street 1:1200 SOUTH PINE ISLAND RD
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324
Practice Address - Country:US
Practice Address - Phone:888-404-4813
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-21
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty