BLUE WATER RAD ONC, LLC (NPI# 1184272817) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1184272817 |
| Entity Type | Organization |
| Organization Name | BLUE WATER RAD ONC, LLC |
| Practice Address |
2601 Electric Ave Port Huron MI 48060-6587 |
| Practice Telephone | 8102162902 |
| Practice Fax Number | 8102163025 |
| Mailing Telephone | 8102162902 |
| Mailing Fax Number | 8102163025 |
| Enumeration Date | 2019-08-27 |
| Last Update Date | 2019-08-27 |
| Authorized Official Name | LISA CATHEY (BILLING/CREDENTIALING) |
| Authorized Official Telephone | 8102161833 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085R0001X |
Radiology Specialization: Radiation Oncology |
Allopathic & Osteopathic Physicians |
| Street Address |
2601 ELECTRIC AVE |
| City | PORT HURON |
| State | MI |
| Zip Code | 48060-6587 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174505069 | H Mcdonald Md, PC | Pathology | 2601 Electric Ave, Port Huron, MI 48060-6587 | 2005-11-16 |
| 1902407844 | Prime Healthcare Services-port Huron LLC | Radiology | 2601 Electric Ave, Port Huron, MI 48060-6587 | 2020-11-06 |
| 1013525070 | Serene Anesthesiology Pllc | Anesthesiology | 2601 Electric Ave, Port Huron, MI 48060-6587 | 2020-07-16 |
| 1912525361 | Prime Healthcare Services-port Huron LLC | Nurse Anesthetist, Certified Registered | 2601 Electric Ave, Port Huron, MI 48060-6587 | 2020-07-13 |
| 1306460787 | Kyle W Doyle | Nurse Anesthetist, Certified Registered | 2601 Electric Ave, Port Huron, MI 48060-6587 | 2020-06-02 |
| 1588121685 | Huron Pathology Associates Pllc | Pathology | 2601 Electric Ave, Port Huron, MI 48060-6587 | 2019-02-25 |
| 1922571280 | Caillie Dianne Stephenson | Speech-Language Pathologist | 2601 Electric Ave, Port Huron, MI 48060-6587 | 2019-01-09 |
| 1356812697 | Aaron T Misner | General Practice | 2601 Electric Ave, Port Huron, MI 48060-6587 | 2018-12-16 |
| 1063987410 | Courtney Sherman | Occupational Therapist | 2601 Electric Ave, Port Huron, MI 48060-6587 | 2018-10-11 |
| 1851875223 | Sohaib Tariq | Physician Assistant | 2601 Electric Ave, Port Huron, MI 48060 | 2018-09-20 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740897297 | Casey Edward Bicker | Behavior Technician | 3245 Keewahdin Rd; Fort Gratiot, Mi 48059, Port Huron, MI 48060 | 2020-09-29 |
| 1962032078 | Brianne Salchert | Peer Specialist | 1170 Michigan Rd., Port Huron, MI 48060 | 2020-01-17 |
| 1982123006 | Kenneth Shine Heuvelman | Counselor | 3522 Holland Park Ln, Port Huron, MI 48060 | 2017-09-11 |
| 1346767506 | Kelly Baker | Social Worker | 520 Superior St., Port Huron, MI 48060 | 2017-08-28 |
| 1326418609 | Jean Burleigh | Chore Provider | 614 Staton, Port Huron, MI 48060 | 2015-09-30 |
| 1205242161 | Lisa Gray | Counselor | 2885 W Rick Dr, Port Huron, MI 48060 | 2014-07-10 |
| 1861758880 | Aaron Overly | Surgery | 2609 Electric Ave Ste B&, Port Huron, MI 48060 | 2012-04-03 |
| 1942591508 | S Akram Ali | Surgery | 3270 Waldheim Dr, Port Huron, MI 48060 | 2011-04-29 |
| 1417258179 | Nicholas Alexander Tobianski | Physician Assistant | 3550 Pine Grove Avenue, Port Huron, MI 48060 | 2010-11-11 |
| 1598092769 | Blue Water Pharmacy LLC | Pharmacy | 1524 10th Street, Port Huron, MI 48060 | 2009-11-10 |
| Find all providers in zip 48060 | ||||
| Taxonomy Code | 2085R0001X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Radiation Oncology |
| A radiologist who deals with the therapeutic applications of radiant energy and its modifiers and the study and management of disease, especially malignant tumors. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902407844 | Prime Healthcare Services-port Huron LLC | Radiology | 2601 Electric Ave, Port Huron, MI 48060-6587 | 2020-11-06 |
| 1215949060 | Kanu B Dalal | Radiology | 1221 Pine Grove Ave, Radiology Dept, Port Huron, MI 48060-3511 | 2006-08-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790300390 | Julian Jeberaeel | Radiology | 2250 Providence, Southfield, MI 48075 | 2020-06-10 |
| 1811444235 | Gwendolyn Henderson Parker | Radiology | 48165 Liberty Dr, Shelby Twp, MI 48315-4061 | 2016-09-01 |
| 1376097733 | Munson Medical Center | Radiology | 217 S Madison Avenue, Traverse City, MI 49684-2320 | 2016-08-15 |
| 1972985737 | Andrew Thompson | Radiology | 44378 Dequindre Rd Fl 1, Sterling Heights, MI 48314-1003 | 2015-06-29 |
| 1093112799 | Wmro LLC | Radiology | 5950 Metro Way, Wyoming, MI 49519 | 2014-11-24 |
| 1932533692 | Compass Healthcare, Plc | Radiology | 2175 Coolidge Rd, East Lansing, MI 48823-1379 | 2013-08-29 |
| 1083903256 | Omar Hesham Gayar | Radiology | 4100 Beecher Rd Ste A, Flint, MI 48532-3661 | 2011-03-28 |
| 1881906519 | Sanath Kumar | Radiology | 18101 Oakwood Blvd Ste 411, Oakwood Hospital, Dearborn, MI 48124-4089 | 2010-07-10 |
| 1376772574 | Matthew W Packard | Radiology | 145 Michigan St Ne - Suite 2200, Lemmen-holton Cancer Pavilion (radiation/oncology), Grand Rapids, MI 49503 | 2009-07-08 |
| 1053575118 | North Macomb Mrt Center LLC | Radiology | 17900 23 Mile Road, Macomb Twp, MI 48042 | 2008-07-17 |
| Find all providers with the same taxonomy | ||||
| City | PORT HURON |
| Zip Code | 48060 |
Please comment or provide details below to improve the information on BLUE WATER RAD ONC, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.