Provider Demographics
NPI:1770647174
Name:BLUE SPRINGS INTERNAL MEDICINE
Entity Type:Organization
Organization Name:BLUE SPRINGS INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:VOSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:816-228-9841
Mailing Address - Street 1:220 NW RR MIZE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64014-2527
Mailing Address - Country:US
Mailing Address - Phone:816-228-9841
Mailing Address - Fax:816-228-3683
Practice Address - Street 1:220 NW R.D. MIZE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64014-2527
Practice Address - Country:US
Practice Address - Phone:816-228-9841
Practice Address - Fax:816-228-3683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1900000CMedicare ID - Type UnspecifiedGROUP ID NUMBER