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General NPI Number Information
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NPI Number | 1104958537
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Entity Type | Organization
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Legal Business Name | BLUE VALLEY WOMEN'S CARE
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Dates
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Enumeration Date | 03/12/2007
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Last Update Date | 07/29/2008
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Provider Practice Location Address
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Address Line | 9375 WEST 75TH STREET
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City | OVERLAND PARK
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State | KS
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Zip | 66204
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Country | US
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Telephone | 913-642-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 9375 WEST 75TH STREET
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City | OVERLAND PARK
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State | KS
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Zip | 66204
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Country | US
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Telephone | 913-642-7000
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JANETTA C. PROVERBS
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Credential | M.D.
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Telephone | 913-642-7000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 04-26209
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License Number State | KS
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