Healthcare Provider Details

I. General information

NPI: 1730127200
Provider Name (Legal Business Name): NEPHROLOGY AND HYPERTENSION SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 01/22/2024
Certification Date: 01/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 BOWLES AVE STE 220
FENTON MO
63026-2384
US

IV. Provider business mailing address

1011 BOWLES AVE STE 220
FENTON MO
63026-2384
US

V. Phone/Fax

Practice location:
  • Phone: 636-681-3030
  • Fax: 636-326-1545
Mailing address:
  • Phone: 636-681-3030
  • Fax: 636-326-1545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JOHN MELLAS
Title or Position: PARTNER
Credential: MD
Phone: 314-842-9669