| Blue Oceanss Llc | |
|
490 Fairbrook St Northville MI 48167-1534 | |
| (248) 862-1040 | |
| Not Available |
| Full Name | Blue Oceanss Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 490 Fairbrook St, Northville, Michigan |
| Authorized Official Name and Position | Austin Rogers (OWNER) |
| Authorized Official Contact | 2488621040 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Blue Oceanss Llc 490 Fairbrook St Northville MI 48167-1534 Ph: () - | Blue Oceanss Llc 490 Fairbrook St Northville MI 48167-1534 Ph: (248) 862-1040 |
| NPI Number | 1669194643 |
|---|---|
| Provider Enumeration Date | 09/15/2022 |
| Last Update Date | 09/15/2022 |
| Medicare PECOS PAC ID | 9537545611 |
|---|---|
| Medicare Enrollment ID | O20220927000770 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669194643 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Carl Dade |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1760690739 PECOS PAC ID: 4183981871 Enrollment ID: I20171205003186 |
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