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General NPI Number Information
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NPI Number | 1720585284
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Entity Type | Organization
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Legal Business Name | BLUEWATER HEALTHCARE PA LLC
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Dates
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Enumeration Date | 04/11/2018
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Last Update Date | 07/02/2024
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Provider Practice Location Address
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Address Line | 1221 GLENWOOD DR
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City | WEST MONROE
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State | LA
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Zip | 71291-5539
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Country | US
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Telephone | 318-366-0125
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2898
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City | WEST MONROE
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State | LA
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Zip | 71294-2898
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Country | US
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Telephone | 318-366-0125
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Fax | 318-654-7466
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL RIGGINS
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Credential |
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Telephone | 318-366-0125
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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