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General NPI Number Information
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NPI Number | 1003730169
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Entity Type | Organization
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Legal Business Name | OPEN WATER MEDICAL, PA
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Dates
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Enumeration Date | 08/10/2026
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Last Update Date | 08/10/2026
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Provider Practice Location Address
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Address Line | 458 HWY 70 EAST
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City | SEA LEVEL
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State | NC
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Zip | 28577
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Country | US
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Telephone | 252-728-5737
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Fax |
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Provider Business Mailing Address
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Address Line | 1620C LIVE OAK ST
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City | BEAUFORT
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State | NC
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Zip | 28516-1583
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Country | US
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Telephone | 252-728-5737
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Fax | 252-723-5739
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Authorized Official
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Title or Position | COO
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Name | SAMUEL WILLIS
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Credential |
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Telephone | 252-723-7234
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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