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General NPI Number Information
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NPI Number | 1780058727
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Entity Type | Organization
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Legal Business Name | ST LOUIS KIDNEY CARE LLC
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Dates
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Enumeration Date | 11/13/2015
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Last Update Date | 07/24/2024
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Provider Practice Location Address
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Address Line | 1265 GRAHAM RD STE 1
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City | FLORISSANT
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State | MO
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Zip | 63031-8018
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Country | US
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Telephone | 314-741-1600
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Fax | 314-741-1677
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Provider Business Mailing Address
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Address Line | 1265 GRAHAM RD STE 1
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City | FLORISSANT
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State | MO
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Zip | 63031-8018
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Country | US
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Telephone | 314-741-1600
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Fax | 314-741-1677
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Authorized Official
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Title or Position | PRESIDENT
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Name | RYAN VALLE
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Credential |
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Telephone | 781-699-9362
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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 |
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License Number State |
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