| Blue Water Diagnostics, Llc | |
|
2014 Ashley Oaks Cir Wesley Chapel FL 33544-6400 | |
| (813) 291-7093 | |
| (888) 789-4755 |
| Full Name | Blue Water Diagnostics, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2014 Ashley Oaks Cir, Wesley Chapel, Florida |
| Authorized Official Name and Position | Alex Ward (OWNER) |
| Authorized Official Contact | 8132917093 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Blue Water Diagnostics, Llc 2437 Bay Area Blvd # 194 Houston TX 77058-1519 Ph: (281) 944-4701 | Blue Water Diagnostics, Llc 2014 Ashley Oaks Cir Wesley Chapel FL 33544-6400 Ph: (813) 291-7093 |
| NPI Number | 1023514114 |
|---|---|
| Provider Enumeration Date | 04/05/2018 |
| Last Update Date | 04/22/2019 |
| Medicare PECOS PAC ID | 2668718107 |
|---|---|
| Medicare Enrollment ID | O20190110000012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023514114 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Mark L Ritch |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1659313732 PECOS PAC ID: 8628049350 Enrollment ID: I20040804001624 |
| Provider Name | Jose M De La Torre |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1881699577 PECOS PAC ID: 2769456045 Enrollment ID: I20040823000949 |
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