BLUE WATER MEDICAL PLLC (NPI# 1336409192) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1336409192 |
| Entity Type | Organization |
| Organization Name | BLUE WATER MEDICAL PLLC |
| Practice Address |
511 Fort St Suite 102 Port Huron MI 48060-3922 |
| Practice Telephone | 8104794769 |
| Practice Fax Number | 8884144545 |
| Mailing Telephone | 8104794769 |
| Mailing Fax Number | 8884144545 |
| Enumeration Date | 2012-05-25 |
| Last Update Date | 2012-05-25 |
| Authorized Official Name | DR. MARCUS K. FREE (PRESIDENT/MEMBER) |
| Authorized Official Telephone | 8104794769 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261Q00000X | Clinic/Center | 4301093347 | MI | Ambulatory Health Care Facilities |
| Street Address |
511 FORT ST SUITE 102 |
| City | PORT HURON |
| State | MI |
| Zip Code | 48060-3922 |
| 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 | 261Q00000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033372818 | Colonial Woods Missionary Church | Clinic/Center | 1101 Military St, Port Huron, MI 48060-5418 | 2008-07-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235730664 | Edward W. Sparrow Hospital Association | Clinic/Center | 2900 Hannah Blvd Ste 204, East Lansing, MI 48823-5382 | 2020-11-03 |
| 1952909558 | Quilted Rose Clinical Services, Pllc | Clinic/Center | 269 Walker St Ste 256, Detroit, MI 48207-4258 | 2020-10-15 |
| 1386250694 | A Better Me Therapy, LLC | Clinic/Center | 2503 S Linden Rd Ste 259, Flint, MI 48532-5462 | 2020-09-22 |
| 1275148165 | Anasthesia Pain Service PC | Clinic/Center | 15350 Michigan Ave, Dearborn, MI 48126 | 2020-09-09 |
| 1659985042 | Passion and Purpose Pediatrics | Clinic/Center | 2944 Olden Oak Ln Apt 204, Auburn Hills, MI 48326-2177 | 2020-09-02 |
| 1710597745 | Renew Child and Family Center | Clinic/Center | 383 Starkweather St, Plymouth, MI 48170-1382 | 2020-08-04 |
| 1467075358 | Shear Pointe Inc | Clinic/Center | 1971 E 14 Mile Rd, Birmingham, MI 48009-7244 | 2020-05-26 |
| 1992326466 | New Healthcare PC | Clinic/Center | 911 Dix St Ste B, Otsego, MI 49078-1609 | 2020-05-06 |
| 1851920581 | Emotional Wellness Group LLC | Clinic/Center | 11956 E Outer Dr, Detroit, MI 48224-2630 | 2020-04-04 |
| 1003445800 | Dr. Chris Popp, PC | Clinic/Center | 107 Aprill Dr Ste 5, Ann Arbor, MI 48103-1956 | 2020-04-03 |
| Find all providers with the same taxonomy | ||||
| City | PORT HURON |
| Zip Code | 48060 |
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| 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.