Organization
BLU SPA & SLAON, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VICKI R KEHR (CEO)
(716) 675-2258
Entity
Organization
Contact information
Practice address
3030 ORCHARD PARK RD, WEST SENECA, NY 14224-4638
(716) 675-2258
Mailing address
3030 ORCHARD PARK RD, WEST SENECA, NY 14224-4638
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
21BL1296864
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000500099004
BLUECROSS BLUESHIELD OF WESTERN NEW YORK
NY
01
—
000524717014
BLUECROSS BLUESHIELD OF WESTERN NEW YORK
NY
Enumeration date
07/28/2009
Last updated
07/28/2009
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