# BLUEWATER PLASTIC SURGERY & COSMETIC CENTER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1861584880
- **Authorized official:** MR. STEVEN J. CLARK M.D. (PRESIDENT)
- **Authorized official phone:** (850) 682-5332

## Contact information

- **Practice address:** 4400 E HIGHWAY 20 STE 501, NICEVILLE, NICEVILLE, FL 32578-8825
- **Practice address phone:** (850) 682-5332
- **Practice address fax:** (850) 683-5333
- **Mailing address:** 4400 E HIGHWAY 20 STE 501, NICEVILLE, NICEVILLE, FL 32578-8825
- **Mailing address phone:** (850) 682-5332
- **Mailing address fax:** (850) 683-5333

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251B00000X | Case Management Agency | ME72670 | FL | Yes |

## Other

- **Enumeration date:** 09/28/2006
- **Last updated:** 08/22/2020