Healthcare Provider Details

I. General information

NPI: 1962777557
Provider Name (Legal Business Name): BLUE SPRINGS EMERGENCY PHYSICIAN SERVICES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2012
Last Update Date: 03/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 NW RD MIZE ROAD
BLUE SPRINGS MO
64014
US

IV. Provider business mailing address

484 TEMPLE HILL RD SUITE 104
NEW WINDSOR NY
12553-5557
US

V. Phone/Fax

Practice location:
  • Phone: 845-565-3700
  • Fax:
Mailing address:
  • Phone: 845-565-3700
  • Fax: 845-565-3696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. ANTHONY R RUVO
Title or Position: CEO
Credential: MD
Phone: 845-565-3700