NPIMap

Organization Active NPI

Blue Water Anesthesia Consultants, PC

  • Anesthesiology Physician
  • Clinton Township, MI
National Provider Identifier
1134437684
Registry record updated Sep 21, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
BLUE WATER ANESTHESIA CONSULTANTS, PC
Practice address
43475 Dalcoma Dr
Clinton Township, MI 48038-3591
Phone
(586) 263-5073
NPI assigned
Sep 17, 2010
Last updated
Sep 21, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. John V Morreale, MDNPI 1194752568
Title
Authorized Representative
Phone
(313) 417-0226

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207L00000X Primary

Addresses

Primary practice location

43475 Dalcoma Dr
Clinton Township, MI 48038-3591

Mailing address

255 W Michigan Ave
Jackson, MI 49201-2218
Phone (517) 787-6440

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 28

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 28

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1284681600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1285027200000",
    "number": "1134437684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "255 W MICHIGAN AVE",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492012218",
            "telephone_number": "517-787-6440",
            "fax_number": "517-787-4146"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "43475 DALCOMA DR",
            "city": "CLINTON TOWNSHIP",
            "state": "MI",
            "postal_code": "480383591",
            "telephone_number": "586-263-5073"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE WATER ANESTHESIA CONSULTANTS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-17",
        "last_updated": "2010-09-21",
        "status": "A",
        "authorized_official_last_name": "MORREALE",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "V",
        "authorized_official_title_or_position": "AUTHORIZED REPRESENTATIVE",
        "authorized_official_telephone_number": "313-417-0226",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clinton Township, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.