Blue Water Health and Wellness LLC

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

BLUE WATER HEALTH AND WELLNESS LLC

Practice address

340 Town Place Ave. Suite 240
Ponte Vedra, FL 32081

Phone

(904) 595-2583

Fax

(904) 595-2584

NPI assigned

Feb 25, 2020

Organization subpart

No

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

Authorized official

Name

Edward P Secunda, MD

Title

President

Phone

(904) 595-2583

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1582588800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582588800000",
    "number": "1396379780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "340 TOWN PLACE AVE. SUITE 240",
            "city": "PONTE VEDRA",
            "state": "FL",
            "postal_code": "32081",
            "telephone_number": "904-595-2583",
            "fax_number": "904-595-2584"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "340 TOWN PLACE AVE. SUITE 240",
            "city": "PONTE VEDRA",
            "state": "FL",
            "postal_code": "32081",
            "telephone_number": "904-595-2583",
            "fax_number": "904-595-2584"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE WATER HEALTH AND WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-25",
        "last_updated": "2020-02-25",
        "certification_date": "2020-02-25",
        "status": "A",
        "authorized_official_last_name": "SECUNDA",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "904-595-2583",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Blue Water Dental of St. Johns
• Bluebird Medical & Wellness Corp
• Bluebird Pediatrics
• Bluewater Wellness Center
• Jennifer Borgio, ATC
• William David Boyd, M.D.

• Multi-Specialty Clinic/Center in Ponte Vedra, FL
• Providers in Ponte Vedra, FL by specialty
• Multi-Specialty Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2020; 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.