Healthcare Provider Details

I. General information

NPI: 1841298171
Provider Name (Legal Business Name): ST. JOSEPH NEPHROLOGY ASSOCIATES, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 03/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1009 W SAINT MAARTENS DR SUITE F
SAINT JOSEPH MO
64506-2963
US

IV. Provider business mailing address

1009 W SAINT MAARTENS DR SUITE F
SAINT JOSEPH MO
64506-2963
US

V. Phone/Fax

Practice location:
  • Phone: 816-232-8145
  • Fax: 816-279-1840
Mailing address:
  • Phone: 816-232-8145
  • Fax: 816-279-1840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberR8D62
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD105262
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberR9428
License Number StateMO

VIII. Authorized Official

Name: DR. SCOTT S BROWN
Title or Position: PRESIDENT
Credential: MD
Phone: 816-232-8145