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Organization

BLUEWATER PATHOLOGY PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. RICHARD T ANDERSON MD (PRESIDENT)
(810) 989-3270
Entity
Organization

Contact information

Practice address
1221 PINE GROVE AVE, PORT HURON, MI 48060-3511
(810) 989-3270
Mailing address
1221 PINE GROVE AVE, PORT HURON, MI 48060-3511
(810) 989-3270

Taxonomy

Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
027930
MIDWEST HEALTH PLAN
MI
01
0G46251
BLUE CROSS BLUE SHIELD
MI
01
1008856 0001
THE WELLNESS PLAN
MI
01
104673
CARE CHOICES
MI
01
1541762
UNITED MINEWORKERS
MI
01
34155
COMMUNITY CHOICE OF MI
MI
01
CH5571
RAILROAD MEDICARE
MI
01
XX32047
HEALTHPLUS OF MI
MI
Enumeration date
10/06/2006
Last updated
08/22/2020
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