Healthcare Provider Details

I. General information

NPI: 1770554842
Provider Name (Legal Business Name): NEPHROLOGY AND HYPERTENSION SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 N NEW BALLAS RD STE 204
CREVE COEUR MO
63141-6836
US

IV. Provider business mailing address

PO BOX 840185
KANSAS CITY MO
64184-0185
US

V. Phone/Fax

Practice location:
  • Phone: 314-991-0137
  • Fax:
Mailing address:
  • Phone: 314-991-0137
  • Fax: 314-991-0603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. LISSA LOPEZ-CONCAGH
Title or Position: OWNER
Credential: MD
Phone: 314-991-0137