Healthcare Provider Details

I. General information

NPI: 1902500630
Provider Name (Legal Business Name): ST LOUIS MEDICAL ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2023
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2651 SHELBY ROAD
POPLAR BLUFF MO
63901-9998
US

IV. Provider business mailing address

1302 WILDHORSE MEADOWS DR
CHESTERFIELD MO
63005-4493
US

V. Phone/Fax

Practice location:
  • Phone: 573-843-8380
  • Fax: 573-843-8381
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: RAGHUVEER KURA
Title or Position: OWNER
Credential: MD
Phone: 636-224-6625