Provider Demographics
NPI:1811060767
Name:BLUE SPRINGS FAMILY CARE PC
Entity type:Organization
Organization Name:BLUE SPRINGS FAMILY CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:816-229-8880
Mailing Address - Street 1:104 N. 7 HIGHWAY
Mailing Address - Street 2:SUITE B
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64014-2726
Mailing Address - Country:US
Mailing Address - Phone:816-229-8880
Mailing Address - Fax:816-229-4363
Practice Address - Street 1:104 N. 7 HIGHWAY
Practice Address - Street 2:SUITE B
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64014-7276
Practice Address - Country:US
Practice Address - Phone:816-229-8880
Practice Address - Fax:816-229-4363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO09239018OtherBCBS OF KC
MO1052OtherCOVENTRY GHP
MO09239018OtherBCBS OF KC