NPIMap

Organization Active NPI

Bluewater Bay Urology LLC

  • Urology Physician
  • Niceville, FL
National Provider Identifier
1992740229
Registry record updated Jan 10, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
Legal business name
BLUEWATER BAY UROLOGY LLC
Practice address
4566 E Highway 20
Suite 102
Niceville, FL 32578-8838
Phone
(850) 897-6005
Fax
(850) 897-6003
NPI assigned
Jun 19, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2008

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

Authorized official

Name
Mickey Pickler
Title
Vice President
Phone
(850) 523-2117

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208800000X Primary

Addresses

Primary practice location

4566 E Highway 20
Suite 102
Niceville, FL 32578-8838

Mailing address

4566 E Highway 20
Suite 102
Niceville, FL 32578-8838
Phone (850) 897-6005

National Provider Directory

National Provider Directory

Locations

4566 E Highway 20
Ste 102
Niceville, FL 32578
Phone (850) 746-2515

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1150675200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1199923200000",
    "number": "1992740229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4566 E HIGHWAY 20",
            "address_2": "SUITE 102",
            "city": "NICEVILLE",
            "state": "FL",
            "postal_code": "325788838",
            "telephone_number": "850-897-6005",
            "fax_number": "850-897-6003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4566 E HIGHWAY 20",
            "address_2": "SUITE 102",
            "city": "NICEVILLE",
            "state": "FL",
            "postal_code": "325788838",
            "telephone_number": "850-897-6005",
            "fax_number": "850-897-6003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUEWATER BAY UROLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-19",
        "last_updated": "2008-01-10",
        "status": "A",
        "authorized_official_last_name": "PICKLER",
        "authorized_official_first_name": "MICKEY",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "850-523-2117"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Urology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Niceville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2008; 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.