1275916934 NPI number — BLUE VALLEY SURGICAL ASSOCIATES, LLC

Table of content: (NPI 1275916934)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275916934 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:
1275916934
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/30/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12920 METCALF AVE
Provider Second Line Business Mailing Address:
STE 250
Provider Business Mailing Address City Name:
OVERLAND PARK
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66213-2699
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-428-4723
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2341 HIGHWAY K
Provider Second Line Business Practice Location Address:
SUITE 214
Provider Business Practice Location Address City Name:
O FALLON
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63368-8604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-542-6020
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/30/2015

Additional Information

Authorized Official

Authorized Official Last Name:
PALZER
Authorized Official First Name:
DOUGLAS
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNWE-CEO
Authorized Official Telephone Number:
913-428-4723

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  2015020560 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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