MEDICARE: BLUE RIDGE SURGICAL CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center	130-1	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00082928	OTHER		RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023010311
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUE RIDGE SURGICAL CENTER, LLC

Provider Business Mailing Address
First Line	:	4240 BLUE RIDGE BLVD
Second Line	:	SUITE 950
City	:	KANSAS CITY
State	:	MO
Zip	:	64133-1713
Country	:	US
Telephone Number	:	816-358-9990
Fax Number	:

Provider Business Practice Location Address
First Line	:	4240 BLUE RIDGE BLVD
Second Line	:	STE 950
City	:	KANSAS CITY
State	:	MO
Zip	:	64133-1755
Country	:	US
Telephone Number	:	816-358-9990
Fax Number	:	816-358-1608

Authorized Official
Title or Position	:	OFFICER AND AUTHORIZED OFFICIAL
Name	:	JENNIFER BOYD BALDOCK
Credential	:
Telephone Number	:	615-234-5954

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	11/03/2022

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