| Blue Waves Primary Care LLC | |
|
106 N Old Kings Rd Ste B Ormond Beach FL 32174-5177 | |
| (386) 944-9808 | |
| Not Available |
| Full Name | Blue Waves Primary Care LLC |
|---|---|
| Speciality | Family Medicine |
| Location | 106 N Old Kings Rd Ste B, Ormond Beach, Florida |
| Authorized Official Name and Position | Craig James Howitt (MANAGING DIRECTOR) |
| Authorized Official Contact | 3869449808 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Blue Waves Primary Care LLC 106 N Old Kings Rd Ste B Ormond Beach FL 32174-5177 Ph: (386) 944-9808 | Blue Waves Primary Care LLC 106 N Old Kings Rd Ste B Ormond Beach FL 32174-5177 Ph: (386) 944-9808 |
| NPI Number | 1447125265 |
|---|---|
| Provider Enumeration Date | 10/09/2025 |
| Last Update Date | 10/09/2025 |
| Certification Date | 10/09/2025 |
| Medicare PECOS PAC ID | 8224510490 |
|---|---|
| Medicare Enrollment ID | O20260305003853 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447125265 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Primary |
| Provider Name | James W Brown |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1770644957 PECOS PAC ID: 4981923414 Enrollment ID: I20150505002914 |
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