MEDICARE: BLUE WATER INTERNAL MEDICINE ASSOCIATES P C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2471B0102X	Bone Densitometry Radiologic Technologist	25652	AZ

General Provider Information

NPI Number	:	1801124656
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUE WATER INTERNAL MEDICINE ASSOCIATES P C

Provider Business Mailing Address
First Line	:	PO BOX 2760
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86405-2760
Country	:	US
Telephone Number	:	928-453-6963
Fax Number	:

Provider Business Practice Location Address
First Line	:	5263 S HIGHWAY 95
Second Line	:	SUITE 101
City	:	FORT MOHAVE
State	:	AZ
Zip	:	86426-9223
Country	:	US
Telephone Number	:	928-453-8100
Fax Number	:

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. BRIAN N SABOWITZ
Credential	:	M.D.
Telephone Number	:	928-453-6963

Provider Enumeration Date	:	12/04/2009
Last Update Date	:	06/18/2010

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