Bluewater Plastic Surgery & Cosmetic Center

Primary specialty

Case Management AgencyTaxonomy code 251B00000X

License

ME72670 Issued in FL

Legal business name

BLUEWATER PLASTIC SURGERY & COSMETIC CENTER

Practice address

4400 E Highway 20 Ste 501
Niceville
Niceville, FL 32578-8825

Phone

(850) 682-5332

Fax

(850) 683-5333

NPI assigned

Sep 28, 2006

Last updated

Aug 22, 2020By 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

Mr. Steven J. Clark, M.D.NPI 1154353720

Title

President

Phone

(850) 682-5332

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Steven J Clark, MD

  • Plastic and Reconstructive Surgery Physician
  • Mount Vernon, IL
  • NPI 1154353720
  NPD (past) Authorized official

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

{
    "created_epoch": "1159401600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1861584880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4400 E HIGHWAY 20 STE 501",
            "address_2": "NICEVILLE",
            "city": "NICEVILLE",
            "state": "FL",
            "postal_code": "325788825",
            "telephone_number": "850-682-5332",
            "fax_number": "850-683-5333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4400 E HIGHWAY 20 STE 501",
            "address_2": "NICEVILLE",
            "city": "NICEVILLE",
            "state": "FL",
            "postal_code": "325788825",
            "telephone_number": "850-682-5332",
            "fax_number": "850-683-5333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUEWATER PLASTIC SURGERY & COSMETIC CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-28",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "850-682-5332",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "FL",
            "license": "ME72670",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bluewater Orthopedics PA
• Bluewater Orthopedics, P.a.
• Bluewater Orthopedics, P.a.
• Bluewater Orthopedics, P.a.
• Bluewater Orthopedics, PA
• Bluewater Primary Care, Inc
• Bluewater Radiology, PLLC (Bluewater Diagnostic Imaging)
• Bluewater Wellness Group LLC
• Amy Elissa Bogan, BSW
• Charae Bond, RPH

• Case Management Agency in Niceville, FL
• Providers in Niceville, FL by specialty
• Case Management Agency in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.