1811154206 NPI number — NEPHROLOGY AND HYPERTENSION CONSULTANTS LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811154206 NPI number — NEPHROLOGY AND HYPERTENSION CONSULTANTS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEPHROLOGY AND HYPERTENSION CONSULTANTS LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811154206
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/12/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
140 JUNGERMANN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT PETERS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63376-1698
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
636-928-0078
Provider Business Mailing Address Fax Number:
636-928-0089

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
621 S NEW BALLAS RD
Provider Second Line Business Practice Location Address:
MERCY DOCTORS BLDG TOWER B SUITE 5003
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63141-8232
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-527-7278
Provider Business Practice Location Address Fax Number:
636-527-7201
Provider Enumeration Date:
05/22/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MINDEL
Authorized Official First Name:
GRAEME
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
636-928-0078

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 205685910 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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