Provider Demographics
NPI:1780628255
Name:BLUEWATER ORTHOPEDICS, PA
Entity type:Organization
Organization Name:BLUEWATER ORTHOPEDICS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:STRICKLAND
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 1:1950 BLUEWATER BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-3887
Practice Address - Country:US
Practice Address - Phone:850-897-8081
Practice Address - Fax:850-897-1520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0060265207RS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14883BOtherBCBSFL
FLF28111Medicare UPIN
FL14883YMedicare ID - Type Unspecified