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General NPI Number Information
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NPI Number | 1548201874
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Entity Type | Organization
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Legal Business Name | NRA-ST. LOUIS, MISSOURI, LLC
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Dates
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Enumeration Date | 06/09/2006
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Last Update Date | 10/17/2023
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Provider Practice Location Address
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Address Line | 2635 HAMPTON AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63139-2912
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Country | US
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Telephone | 314-646-1717
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Fax | 314-646-0636
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Provider Business Mailing Address
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Address Line | 2635 HAMPTON AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63139-2912
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Country | US
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Telephone | 314-646-1717
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Fax | 314-646-0636
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | BARRY L. BLANTON
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Credential |
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Telephone | 781-699-9000
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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 | N/A
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License Number State | MO
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