ST LOUIS KIDNEY, LLC (NPI# 1114344348) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114344348 |
| Entity Type | Organization |
| Organization Name | ST LOUIS KIDNEY, LLC |
| Practice Address |
12855 N 40 Dr Suite 205 Saint Louis MO 63141-8657 |
| Practice Telephone | 3147200900 |
| Practice Fax Number | 3145790108 |
| Mailing Telephone | 3147200900 |
| Mailing Fax Number | 3145790108 |
| Enumeration Date | 2014-03-26 |
| Last Update Date | 2014-03-26 |
| Authorized Official Name | DR. JAY SELTZER (AUTHORIZED MEMBER) |
| Authorized Official Telephone | 3148250361 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM2500X |
Clinic/Center Specialization: Medical Specialty |
Ambulatory Health Care Facilities |
| Street Address |
12855 N 40 DR SUITE 205 |
| City | SAINT LOUIS |
| State | MO |
| Zip Code | 63141-8657 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942206354 | St. Louis Pharmaceutical Services LLC | Pharmacy | 12855 N 40 Dr, Saint Louis, MO 63141-8635 | 2005-06-22 |
| 1700423076 | Faisal Matar | Nurse Practitioner | 12855 N 40 Dr, Saint Louis, MO 63141-8622 | 2019-12-05 |
| 1750847984 | Samantha Mintert | Nurse Practitioner | 12855 N 40 Dr, Saint Louis, MO 63141-8622 | 2019-02-12 |
| 1629439302 | Elizabeth Galler | Physician Assistant | 12855 N 40 Dr, 180, Saint Louis, MO 63141-8657 | 2016-03-09 |
| 1992161210 | Amy Thayer | Nurse Practitioner | 12855 N 40 Dr, Suite 180, Saint Louis, MO 63141-8657 | 2016-01-04 |
| 1821453796 | Mason Ridge Ambulatory Surgery Center Lp | Clinic/Center | 12855 N 40 Dr, Suite 150, Saint Louis, MO 63141-8657 | 2015-12-21 |
| 1083090088 | Rebecca Suzanne Roe Thomasson | Physician Assistant | 12855 N 40 Dr, Suite 180, Saint Louis, MO 63141-8657 | 2015-08-03 |
| 1891179040 | Forefront Dermatology, S.c. | Dermatology | 12855 N 40 Dr, Suite 180, Saint Louis, MO 63141 | 2015-07-17 |
| 1669869657 | Christopher Joseph Forsbach | Podiatrist | 12855 N 40 Dr, Saint Louis, MO 63141 | 2015-04-17 |
| 1346633930 | Chesterfield Anesthesia Associates of Missouri, LLC | Anesthesiology | 12855 N 40 Dr, 150, Saint Louis, MO 63141-8657 | 2015-03-06 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679102842 | Noor Ramadan | Pharmacist | 628 North New Ballad Road, Suite A, Creve Coeur, MO 63141 | 2020-04-08 |
| 1497381206 | Washington University | Durable Medical Equipment & Medical Supplies | 1044 North Mason Road, Suite 110/210, St. Louis, MO 63141 | 2020-03-13 |
| 1154956498 | Ashleigh Clendenny | Physician Assistant | Mercy Hospital St. Louis, 615 S New Ballas Rd, St. Louis, MO 63141 | 2020-03-06 |
| 1801429410 | Emili Lou Haley | Registered Nurse | 650 Maryville Drive, St Louis, MO 63141 | 2020-02-21 |
| 1629553110 | Rebecca Kathleen Pike | Social Worker | West County Psychological Associates, 12125 Woodcrest Executive Drive #110, St. Louis, MO 63141 | 2018-10-01 |
| 1649756099 | River City Sedation Associates, LLC | Nurse Anesthetist, Certified Registered | 12855 N 40 Dr Ste 150, Saint Louis, MO 63141 | 2018-07-18 |
| 1205333952 | Ear Care and Hearing of St. Louis | Hearing Aid Equipment | 11630 Studt Ave Ste 210, Creve Coeur, MO 63141 | 2018-04-10 |
| 1659897486 | Erin Goodman | Physical Therapist | 10560 Old Olive St. Rd, Suite 100, Creve Coeur, MO 63141 | 2017-08-14 |
| 1093230450 | Center for Urologic Surgery LLC | Clinic/Center | 12855 N 40 Dr Ste 100, Saint Louis, MO 63141 | 2017-08-07 |
| 1871016105 | Jacob Farley Tanner | Specialist/Technologist | 1054 Town and Four Parkway Dr, Creve Coeur, MO 63141 | 2017-07-19 |
| Find all providers in zip 63141 | ||||
| Taxonomy Code | 261QM2500X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Medical Specialty |
| An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer). |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871044735 | Susan D Purcell Md Dermatology LLC | Clinic/Center | 969 N Mason Rd Ste 170, Saint Louis, MO 63141-6387 | 2016-10-16 |
| 1154730414 | Mohammed Z Siddiqui Medical Consulting LLC | Clinic/Center | 10 Overbrook Dr, Saint Louis, MO 63124-1482 | 2014-08-11 |
| 1376875393 | Ballas Chiropractic Centre Inc | Clinic/Center | 11639 Studt Ave, Saint Louis, MO 63141-7015 | 2010-02-01 |
| 1285664268 | Physician Groups Lc | Clinic/Center | 670 Mason Ridge Center Dr, Suite 300, Saint Louis, MO 63141-8573 | 2006-07-04 |
| 1437185782 | Missouri Cvs Pharmacy, L.L.C. | Clinic/Center | 6600 Clayton Rd, Saint Louis, MO 63117-1602 | 2006-06-25 |
| 1104861129 | Missouri Cvs Pharmacy, L.L.C. | Clinic/Center | 10650 Olive Blvd, Saint Louis, MO 63141-7834 | 2006-06-17 |
| 1730540196 | Vein Specialties and Medi-spa, LLC | Clinic/Center | 1035 Bellevue Ave Ste 212, Saint Louis, MO 63117-1846 | 2016-03-14 |
| 1003246026 | True Results Missouri, LLC | Clinic/Center | 12855 N 40 Dr, Suite 275, Saint Louis, MO 63141-8657 | 2013-11-13 |
| 1811268428 | Joseph M Seria Md LLC | Clinic/Center | 3915 Watson Rd, Suite 204, Saint Louis, MO 63109-1251 | 2012-01-13 |
| 1346576709 | The Youthful Body, Inc. | Clinic/Center | 10287 Clayton Rd, Suite 200, Saint Louis, MO 63124-1172 | 2009-10-20 |
| Find all providers in SAINT LOUIS | ||||
| City | SAINT LOUIS |
| Zip Code | 63141 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.