Open Water Medical, PA
Organization Active NPI Clinic/Center · Goldsboro, NC
NPI 1720550940 · NPPES record last updated Feb 24, 2022
Key facts
- NPI
- 1720550940
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinic/Center 261Q00000X
- Legal business name
- OPEN WATER MEDICAL, PA
- Practice address
- 1209 E Ash St
Goldsboro, NC 27530-5103 - Phone
- (919) 734-9455
- Fax
- (919) 734-4769
- NPI assigned
- Dec 28, 2018
- Organization subpart
- No
Authorized official
- Name
- Tisha Rae Smith
- Title
- Practice Manager
- Phone
- (252) 728-5737
Corporate family (same tax ID) 5
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 34D0239917 | Open Water Medical, PA | Provider-performed microscopy | Aug 31, 2026 |
National Provider Directory
- Tax ID family
- Open Water Medical PA
Locations
1620C Live Oak St
Beaufort, NC 28516
Phone (252) 728-5737
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | |||
| Clinic/Center | 261Q00000X | Yes |
Addresses
Primary practice location
1209 E Ash St
Goldsboro, NC 27530-5103
Mailing address
1620C Live Oak St
Beaufort, NC 28516-1583
Phone (252) 728-5737
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | http://www.openwatermedical.com/ | Other | |
| Other URL | www.carecloud.com | Health Information Exchange (HIE) |
Other providers in Goldsboro, NC
- Alfred E Okeke
- Tumininu Gladys Oloniboko
- Omid Khaksarfard DDS PLLC
- Omni Family of Services North Carolina Inc.
- One to One With Youth, Inc.
- Openarmsofgoldsboro
- Katherine Openshaw
- Sofia Osorio
- Stephen Allen Otanes
- James Otey
All providers in Goldsboro, NC · Clinic/Center in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 24, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.