Blue Valley Surgical Associates, LLC
Nurse Practitioner, Family in O Fallon, MO. Organization (NPI-2).
NPI number1275916934
StatusActive
Last updated in NPPESJun 30, 2015
Details
- NPI
- 1275916934
- Entity type
- Organization (NPI-2)
- Legal business name
- Blue Valley Surgical Associates, LLC
- Organization subpart
- No
- Enumeration date
- Jun 30, 2015
- Last updated
- Jun 30, 2015
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LF0000X | Nurse Practitioner, Family | 2015020560 | MO | Yes |
Practice location
2341 Highway KSuite 214
O Fallon, MO 63368-8604
Phone 636-542-6020
Mailing address
12920 Metcalf AveSte 250
Overland Park, KS 66213-2699
Phone 913-428-4723
Authorized official
Douglas Palzer
Ownwe-Ceo
9134284723
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