Provider Demographics
NPI:1811168263
Name:METRO ST LOUIS RENAL SERVICES, INC
Entity type:Organization
Organization Name:METRO ST LOUIS RENAL SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BHAJAN
Authorized Official - Middle Name:SHEWALDAS
Authorized Official - Last Name:DARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-869-0370
Mailing Address - Street 1:1234 LAY RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63124-1872
Mailing Address - Country:US
Mailing Address - Phone:314-323-4492
Mailing Address - Fax:800-469-1494
Practice Address - Street 1:777 S NEW BALLAS RD STE 328W
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8748
Practice Address - Country:US
Practice Address - Phone:314-869-0370
Practice Address - Fax:314-869-5098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-13
Last Update Date:2022-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO105728207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO506118603Medicaid
MO000013748Medicare PIN