Organization Name:  BLUE RIDGE SURGICAL CENTER, LLC


Practice Location:
4240 BLUE RIDGE BLVD STE 950 KANSAS CITY, MO 64133 US
Tel: 816-358-9990  Fax: --

Business Mailing Address:
  ,   
Tel: --  Fax: --


Taxonomy:

Primary	Code	Category/Description	State	License Number
Y	261QA1903X	Ambulatory Health Care Facilities Clinic/Center Ambulatory Surgical	MO	130-1

Other Provider Identifiers:

Issuer	Number	State	Type
RR MEDICARE	P00082928		01
	506099100	MO	05

Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin