Blue Water Urgent Care Port Huron

Primary specialty

Urgent Care Clinic/CenterTaxonomy code 261QU0200X

Legal business name

BLUE WATER URGENT CARE PORT HURON

Practice address

1612 10TH Ave
Port Huron, MI 48060-3303

Phone

(810) 660-0242

NPI assigned

Apr 19, 2023

Last updated

Apr 19, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Ibrahim Dabaja, PA-C, PH.D.

Title

President

Phone

(810) 660-0242

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1681862400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681862400000",
    "number": "1548957707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1612 10TH AVE",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480603303",
            "telephone_number": "810-660-0242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1612 10TH AVE",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480603303",
            "telephone_number": "810-660-0242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE WATER URGENT CARE PORT HURON",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-19",
        "last_updated": "2023-04-19",
        "certification_date": "2023-04-19",
        "status": "A",
        "authorized_official_last_name": "DABAJA",
        "authorized_official_first_name": "IBRAHIM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "810-660-0242",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PA-C, PH.D."
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Urgent Care Clinic/Center in Port Huron, MI
• Providers in Port Huron, MI by specialty
• Urgent Care Clinic/Center in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.