Provider Demographics
NPI:1104993385
Name:SURGERY CENTER OF BLUE VALLEY, INC
Entity type:Organization
Organization Name:SURGERY CENTER OF BLUE VALLEY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:B
Authorized Official - Last Name:LAHA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:913-338-4440
Mailing Address - Street 1:7230 WEST 129TH STREET
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213-2624
Mailing Address - Country:US
Mailing Address - Phone:913-338-4440
Mailing Address - Fax:913-338-1712
Practice Address - Street 1:7230 WEST 129TH STREET
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66213-2624
Practice Address - Country:US
Practice Address - Phone:913-338-4440
Practice Address - Fax:913-338-1712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2008-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
91361018OtherBCBS
91361018OtherBCBS