Provider Demographics
NPI:1780666032
Name:AFFILIATED HOSPITALS DIALYSIS CENTER
Entity Type:Organization
Organization Name:AFFILIATED HOSPITALS DIALYSIS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:KNARR
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:314-434-4770
Mailing Address - Street 1:1009 EXECUTIVE PARKWAY DR
Mailing Address - Street 2:
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6324
Mailing Address - Country:US
Mailing Address - Phone:314-434-4770
Mailing Address - Fax:314-434-1908
Practice Address - Street 1:850 HORAN DR
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-2408
Practice Address - Country:US
Practice Address - Phone:636-305-1144
Practice Address - Fax:636-305-1177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-14
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
262553Medicare ID - Type Unspecified