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General NPI Number Information
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NPI Number | 1174601124
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Entity Type | Organization
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Legal Business Name | ST. LOUIS NEPHROLOGY AND HYPERTENSION
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 09/10/2024
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Provider Practice Location Address
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Address Line | 2102 VADALABENE DR
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City | MARYVILLE
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State | IL
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Zip | 62062-5632
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Country | US
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Telephone | 618-288-1196
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 797021
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City | SAINT LOUIS
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State | MO
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Zip | 63179-7000
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Country | US
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Telephone | 314-644-3535
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. HENRY E PURCELL
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Credential | M.D.
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Telephone | 314-276-7664
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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 | R9H62
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License Number State | MO
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