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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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