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General NPI Number Information
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NPI Number | 1114344348
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Entity Type | Organization
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Legal Business Name | ST LOUIS KIDNEY, LLC
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Dates
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Enumeration Date | 03/26/2014
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Last Update Date | 03/26/2014
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Provider Practice Location Address
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Address Line | 12855 N 40 DR SUITE 205
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City | SAINT LOUIS
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State | MO
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Zip | 63141-8657
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Country | US
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Telephone | 314-720-0900
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Fax | 314-579-0108
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Provider Business Mailing Address
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Address Line | 12855 N 40 DR SUITE 205
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City | SAINT LOUIS
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State | MO
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Zip | 63141-8657
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Country | US
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Telephone | 314-720-0900
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Fax | 314-579-0108
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Authorized Official
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Title or Position | AUTHORIZED MEMBER
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Name | DR. JAY SELTZER
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Credential | M.D.
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Telephone | 314-825-0361
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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