Provider Demographics
NPI:1174630909
Name:SAINT LOUIS RENAL CARE, LLC
Entity Type:Organization
Organization Name:SAINT LOUIS RENAL CARE, LLC
Other - Org Name:FRESENIUS MEDICAL CARE-FOREST PARK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:FAWCETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-402-9000
Mailing Address - Street 1:1400 STRASSNER ROAD
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63144
Mailing Address - Country:US
Mailing Address - Phone:314-768-3011
Mailing Address - Fax:314-768-3560
Practice Address - Street 1:1400 STRASSNER ROAD
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:MO
Practice Address - Zip Code:63144
Practice Address - Country:US
Practice Address - Phone:314-768-3011
Practice Address - Fax:314-768-3560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO26-2593Medicare ID - Type Unspecified