Provider Demographics
NPI:1003145335
Name:NEPHROLOGY ASSOCIATES OF ST. LOUIS
Entity Type:Organization
Organization Name:NEPHROLOGY ASSOCIATES OF ST. LOUIS
Other - Org Name:NEPHROLOGY ASSOCIATES OF ST. LOUIS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PAVLOPOULOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-720-0900
Mailing Address - Street 1:12855 N FORTY DRIVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8657
Mailing Address - Country:US
Mailing Address - Phone:314-720-0900
Mailing Address - Fax:
Practice Address - Street 1:12855 N FORTY DRIVE
Practice Address - Street 2:SUITE 205
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8657
Practice Address - Country:US
Practice Address - Phone:314-720-0900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-16
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty