Blue Water Podiatry PC

Primary specialty

PodiatristTaxonomy code 213E00000X

License

59000955 Issued in MI

Legal business name

BLUE WATER PODIATRY PC

Practice address

1060 S Van Dyke Rd
Suite 100
Bad Axe, MI 48413-9631

Phone

(989) 269-9575

Fax

(989) 269-9576

NPI assigned

Jan 31, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Thomas Ernst, DPMNPI 1174520274

Title

Owner

Phone

(989) 269-9575

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Thomas Kevin Ernst, DPM

  • Foot & Ankle Surgery Podiatrist
  • Port Huron, MI
  • NPI 1174520274
  NPD (past) Authorized official

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

{
    "created_epoch": "1170201600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1263945600000",
    "number": "1447397138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5303 SHOREWOOD DR",
            "city": "FORT GRATIOT",
            "state": "MI",
            "postal_code": "480593137",
            "telephone_number": "810-385-2053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1060 S VAN DYKE RD",
            "address_2": "SUITE 100",
            "city": "BAD AXE",
            "state": "MI",
            "postal_code": "484139631",
            "telephone_number": "989-269-9575",
            "fax_number": "989-269-9576"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE WATER PODIATRY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-31",
        "last_updated": "2010-01-20",
        "status": "A",
        "authorized_official_last_name": "ERNST",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "989-269-9575",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist",
            "state": "MI",
            "license": "59000955",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1958354",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Scott Michael Behnan, D.D.S, M.S,
• Sandy Behnke, B.C.,D.C
• Stefanie Behnke
• Michael T Bills, DDS
• Michele Lynn Bingle, MSED., ED.S
• Kelsey Bodis
• Alexis Danielle Bogart-Venenziano
• Jean Booms
• Julia Booms, LLMSW
• Kaileigh Booms

• Podiatrist in Bad Axe, MI
• Providers in Bad Axe, MI by specialty
• Podiatrist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 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.