Healthcare Provider Details

I. General information

NPI: 1528133535
Provider Name (Legal Business Name): MIDWEST NEPHROLOGY ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 01/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 JUNGERMANN CIR SUITE 405
SAINT PETERS MO
63376-1622
US

IV. Provider business mailing address

70 JUNGERMANN CIR SUITE 405
SAINT PETERS MO
63376-1622
US

V. Phone/Fax

Practice location:
  • Phone: 636-720-0310
  • Fax: 636-441-0620
Mailing address:
  • Phone: 636-720-0310
  • Fax: 636-441-0620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number108436
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number133141
License Number StateMO

VIII. Authorized Official

Name: DR. GARY G SINGER
Title or Position: PHYSICIAN PRESIDENT
Credential: MD
Phone: 636-720-0310