Provider Demographics
NPI:1841298171
Name:ST. JOSEPH NEPHROLOGY ASSOCIATES, P.A.
Entity type:Organization
Organization Name:ST. JOSEPH NEPHROLOGY ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:S
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:816-232-8145
Mailing Address - Street 1:1009 W SAINT MAARTENS DR
Mailing Address - Street 2:SUITE F
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-2963
Mailing Address - Country:US
Mailing Address - Phone:816-232-8145
Mailing Address - Fax:816-279-1840
Practice Address - Street 1:1009 W SAINT MAARTENS DR
Practice Address - Street 2:SUITE F
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-2963
Practice Address - Country:US
Practice Address - Phone:816-232-8145
Practice Address - Fax:816-279-1840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-11
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR8D62207RN0300X
MOMD105262207RN0300X
MOR9428207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO502578909Medicaid
MO502578909Medicaid