Provider Demographics
NPI:1821696386
Name:BLUE OCEAN HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:BLUE OCEAN HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KARA
Authorized Official - Middle Name:CHARLOTTE
Authorized Official - Last Name:FARLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-785-2476
Mailing Address - Street 1:105 CLARIDEN RANCH RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-1947
Mailing Address - Country:US
Mailing Address - Phone:817-835-6363
Mailing Address - Fax:817-818-1313
Practice Address - Street 1:105 CLARIDEN RANCH RD
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-1947
Practice Address - Country:US
Practice Address - Phone:817-835-6363
Practice Address - Fax:817-818-1313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXQ9605OtherTEXAS LICENSE
1497148613OtherNPI