Blue Water Podiatry PC

Primary specialty

PodiatristTaxonomy code 213E00000X

License

59000955 Issued in MI

Legal business name

BLUE WATER PODIATRY PC

Practice address

828 10TH Ave
Port Huron, MI 48060-3640

Phone

(810) 982-4240

Fax

(810) 982-2479

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 K Ernst, DPM

Title

Owner

Phone

(810) 982-4240

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1170201600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1192752000000",
    "number": "1760529705",
    "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": "828 10TH AVE",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480603640",
            "telephone_number": "810-982-4240",
            "fax_number": "810-982-2479"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE WATER PODIATRY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-31",
        "last_updated": "2007-10-19",
        "status": "A",
        "authorized_official_last_name": "ERNST",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "810-982-4240",
        "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": "1958336",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Podiatrist in Port Huron, MI
• Providers in Port Huron, MI by specialty
• Podiatrist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2007; 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.