1346356672 NPI number — NEPHROLOGY CONCEPTS LLC

Table of content: (NPI 1346356672)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346356672 NPI number — NEPHROLOGY CONCEPTS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEPHROLOGY CONCEPTS 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:
6
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:
1346356672
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/04/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 12441
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
63132
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-741-4411
Provider Business Mailing Address Fax Number:
314-741-4430

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11125 DUNN RD
Provider Second Line Business Practice Location Address:
STE 410
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63136
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-741-4411
Provider Business Practice Location Address Fax Number:
314-741-4430
Provider Enumeration Date:
08/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FRENCHIE
Authorized Official First Name:
DEBRA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
314-741-4411

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: DE1937 . This is a "RAILROAD MCR" identifier . This identifiers is of the category "OTHER".




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