Provider Demographics
NPI:1114344348
Name:ST LOUIS KIDNEY, LLC
Entity Type:Organization
Organization Name:ST LOUIS KIDNEY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:SELTZER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-825-0361
Mailing Address - Street 1:12855 N 40 DR
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:314-579-0108
Practice Address - Street 1:12855 N 40 DR
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:314-579-0108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-26
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty