1598095580 NPI number — BLUE VALLEY SURGICAL ASSOCIATES, LLC

Table of content: (NPI 1598095580)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598095580 NPI number — BLUE VALLEY SURGICAL ASSOCIATES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BLUE VALLEY SURGICAL ASSOCIATES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598095580
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/12/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 24406
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHAWNEE MISSION
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66283-4406
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-492-0160
Provider Business Mailing Address Fax Number:
913-239-0372

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12850 METCALF AVE
Provider Second Line Business Practice Location Address:
SUITE 220
Provider Business Practice Location Address City Name:
OVERLAND PARK
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66213-2622
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-492-0160
Provider Business Practice Location Address Fax Number:
913-239-0372
Provider Enumeration Date:
01/13/2010

Additional Information

Authorized Official

Authorized Official Last Name:
PALZER
Authorized Official First Name:
DOUGLAS
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
913-940-1675

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  4373114 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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