Provider Demographics
NPI:1598095580
Name:BLUE VALLEY SURGICAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:BLUE VALLEY SURGICAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:PALZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-940-1675
Mailing Address - Street 1:PO BOX 24406
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66283-4406
Mailing Address - Country:US
Mailing Address - Phone:913-492-0160
Mailing Address - Fax:913-239-0372
Practice Address - Street 1:12850 METCALF AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66213-2622
Practice Address - Country:US
Practice Address - Phone:913-492-0160
Practice Address - Fax:913-239-0372
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BLUE VALLEY HOSPITAL, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-01-13
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS4373114174400000X
208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty