Provider Demographics
NPI:1619912797
Name:ST LOUIS NEPHROLOGY ASSOCIATES LLC
Entity Type:Organization
Organization Name:ST LOUIS NEPHROLOGY ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GOPAL
Authorized Official - Middle Name:
Authorized Official - Last Name:KRISHNAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-843-3449
Mailing Address - Street 1:PO BOX 840132
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64184-0132
Mailing Address - Country:US
Mailing Address - Phone:314-843-3449
Mailing Address - Fax:314-843-8762
Practice Address - Street 1:10004 KENNERLY RD STE 361B
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2141
Practice Address - Country:US
Practice Address - Phone:314-843-3449
Practice Address - Fax:314-843-8762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CS0823OtherRAILROAD MEDICARE
IL203885Medicare PIN
IL203885Medicare Oscar/Certification
MO000013440Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER