Blue Water Urgent Care Marysville

Primary specialty

Urgent Care Clinic/CenterTaxonomy code 261QU0200X

Legal business name

BLUE WATER URGENT CARE MARYSVILLE

Practice address

1600 Gratiot Blvd
Marysville, MI 48040-1145

Phone

(810) 676-3360

NPI assigned

Jul 8, 2024

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, PHD

Title

President

Phone

(810) 676-3360

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": "1720396800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720396800000",
    "number": "1821834805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 GRATIOT BLVD",
            "city": "MARYSVILLE",
            "state": "MI",
            "postal_code": "480401145"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 GRATIOT BLVD",
            "city": "MARYSVILLE",
            "state": "MI",
            "postal_code": "480401145",
            "telephone_number": "810-676-3360"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE WATER URGENT CARE MARYSVILLE",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-08",
        "last_updated": "2024-07-08",
        "certification_date": "2024-07-08",
        "status": "A",
        "authorized_official_last_name": "DABAJA",
        "authorized_official_first_name": "IBRAHIM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "810-676-3360",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PA-C, PHD"
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Ashley Ann Bolsby
• Olivia Paige Borton
• Jennifer Boucher
• Jessica E Boucher
• Nancy Boucher

• Urgent Care Clinic/Center in Marysville, MI
• Providers in Marysville, 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 Jul 8, 2024; 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.