Provider Demographics
NPI:1538229273
Name:BLUEWATER ORTHOPEDICS PA
Entity type:Organization
Organization Name:BLUEWATER ORTHOPEDICS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:P
Authorized Official - Last Name:MARKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-897-8081
Mailing Address - Street 1:1950 BLUEWATER BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-3887
Mailing Address - Country:US
Mailing Address - Phone:850-897-8081
Mailing Address - Fax:850-897-1520
Practice Address - Street 1:7720 HWY 98 W
Practice Address - Street 2:SUITE 200
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32550-7321
Practice Address - Country:US
Practice Address - Phone:850-622-3713
Practice Address - Fax:850-622-3721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL40238Medicare PIN
FL0893890002Medicare NSC