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Organization
BLUE RIDGE SURGICAL CENTER, LLC
Active
Organization
BLUE RIDGE SURGICAL CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER BOYD BALDOCK (OFFICER AND AUTHORIZED OFFICIAL)
(615) 234-5954
Entity
Organization
Contact information
Practice address
4240 BLUE RIDGE BLVD, STE 950, KANSAS CITY, MO 64133-1755
(816) 358-9990
(816) 358-1608
Mailing address
4240 BLUE RIDGE BLVD, SUITE 950, KANSAS CITY, MO 64133-1713
(816) 358-9990
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
130-1
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
506099100
—
MO
01
—
P00082928
RR MEDICARE
—
Enumeration date
06/01/2005
Last updated
11/03/2022
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