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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