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General NPI Number Information
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NPI Number | 1093042566
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Entity Type | Organization
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Legal Business Name | BENTLEY RENAL CARE, PC
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Dates
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Enumeration Date | 11/04/2009
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Last Update Date | 08/09/2023
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Provider Practice Location Address
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Address Line | 247 DUNN RD
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City | FLORISSANT
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State | MO
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Zip | 63031-7928
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Country | US
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Telephone | 314-438-0700
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Fax | 314-438-0737
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Provider Business Mailing Address
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Address Line | PO BOX 1449
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City | MARYLAND HEIGHTS
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State | MO
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Zip | 63043-0449
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Country | US
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Telephone | 314-438-0700
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | FELICIA RENAE BENTLEY
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Credential | M.D.
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Telephone | 314-438-0700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 036107319
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License Number State | IL
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