Provider Demographics
NPI:1801124656
Name:BLUE WATER INTERNAL MEDICINE ASSOCIATES P C
Entity type:Organization
Organization Name:BLUE WATER INTERNAL MEDICINE ASSOCIATES P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:N
Authorized Official - Last Name:SABOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-453-6963
Mailing Address - Street 1:PO BOX 2760
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86405-2760
Mailing Address - Country:US
Mailing Address - Phone:928-453-6963
Mailing Address - Fax:
Practice Address - Street 1:5263 S HIGHWAY 95
Practice Address - Street 2:SUITE 101
Practice Address - City:FORT MOHAVE
Practice Address - State:AZ
Practice Address - Zip Code:86426-9223
Practice Address - Country:US
Practice Address - Phone:928-453-8100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BLUE WATER INTERNAL MEDICINE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-12-04
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ256522471B0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471B0102XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistBone DensitometryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ109221Medicare PIN