Provider Demographics
NPI:1417150178
Name:ST. LOUIS RENAL CARE LLC GRAND
Entity Type:Organization
Organization Name:ST. LOUIS RENAL CARE LLC GRAND
Other - Org Name:FRESENIUS MEDICAL CARE GRAND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AREA MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:GERDI
Authorized Official - Middle Name:
Authorized Official - Last Name:WINKLER
Authorized Official - Suffix:
Authorized Official - Credentials:RN CNN
Authorized Official - Phone:314-872-7025
Mailing Address - Street 1:3691 RUTGER ST
Mailing Address - Street 2:SUITE 222
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-2515
Mailing Address - Country:US
Mailing Address - Phone:314-268-5063
Mailing Address - Fax:314-268-5115
Practice Address - Street 1:3691 RUTGER ST
Practice Address - Street 2:SUITE 222
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-2515
Practice Address - Country:US
Practice Address - Phone:314-268-5063
Practice Address - Fax:314-268-5115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-08
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
262549Medicare ID - Type Unspecified