Provider Demographics
NPI:1770554842
Name:NEPHROLOGY AND HYPERTENSION SPECIALISTS, LLC
Entity type:Organization
Organization Name:NEPHROLOGY AND HYPERTENSION SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ-CONCAGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-991-0137
Mailing Address - Street 1:PO BOX 840185
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64184-0185
Mailing Address - Country:US
Mailing Address - Phone:314-991-0137
Mailing Address - Fax:314-991-0603
Practice Address - Street 1:450 N NEW BALLAS RD STE 204
Practice Address - Street 2:
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-6836
Practice Address - Country:US
Practice Address - Phone:314-991-0137
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-27
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO505711804Medicaid
MOMA2661Medicare PIN
MO505711804Medicaid