Provider Demographics
NPI:1235895137
Name:BLUEWATER SURGICAL, PLLC
Entity Type:Organization
Organization Name:BLUEWATER SURGICAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:J
Authorized Official - Last Name:HELAK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:910-262-1048
Mailing Address - Street 1:1711 VERRAZZANO PL
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-4039
Mailing Address - Country:US
Mailing Address - Phone:910-262-1048
Mailing Address - Fax:910-256-6039
Practice Address - Street 1:1717 SHIPYARD BLVD
Practice Address - Street 2:STE 300
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-8019
Practice Address - Country:US
Practice Address - Phone:910-262-1048
Practice Address - Fax:910-256-6039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-15
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty