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General NPI Number Information
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NPI Number | 1538235809
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Entity Type | Organization
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Legal Business Name | AFFILIATED HOSPITALS DIALYSIS CENTER
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Dates
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Enumeration Date | 11/28/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 257 CLARKSON RD
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City | ELLISVILLE
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State | MO
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Zip | 63011-2219
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Country | US
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Telephone | 314-434-4770
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Fax |
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Provider Business Mailing Address
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Address Line | 1009 EXECUTIVE PARKWAY DR
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City | CREVE COEUR
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State | MO
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Zip | 63141-6324
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Country | US
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Telephone | 314-434-4770
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Fax | 314-434-1908
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Authorized Official
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Title or Position | EXECUTIVE VICE PRESIDENT
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Name | CONNIE LYNN KNARR
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Credential | R.N.
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Telephone | 314-434-4770
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0700X
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Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
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License Number |
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License Number State |
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